Application for Admission - Rivier University

Application rivier.edu/PsyD
Division of Education
Doctor of Psychology
in Counseling and School Psychology
Please type or print responses and return your completed application to:
Office of Graduate Admissions,
Rivier University, 420 South Main Street, Nashua, NH 03060-5086
Emailed documents are encouraged and must be sent directly from the primary source (transcripts, letters of recommendation,
essays, and résumés/vitae etc.). Emailed material should be addressed to psyd@rivier.edu.
Application Material
1. Application form: With a non-refundable $100 application fee. Checks should be made payable to Rivier University.
2. Official transcripts: From all colleges or universities attended.
3. GRE test scores: Within the last five calendar years in Verbal Reasoning, Quantitative Reasoning, and Analytic Writing,
as well as the Psychology subject test.
4. Current résumé or curriculum vitae: documenting at least three years of professional experience.
5. Statement of Purpose: A three-page essay that states your professional experience and how that experience relates to your
intended doctoral study; your rationale for pursuing doctoral study; a statement of a research interest; problem, or question
you intend to pursue through doctoral study or are interested in researching; and the ways in which doctoral study will
contribute to your personal and professional experience and enhance your career goals and plans.
6. Three letters of recommendation:
• One from a present or former employer who can address your professional experience and leadership potential.
• One from a current or former professor or colleague who can discuss your ability and potential for advanced course work,
scholarship, and research.
• One from someone who can speak to your personal and professional character.

Full Legal Name
Last First Middle
Female
Male
Other names that may appear on supporting documents Email address U.S. Social Security number
Current Mailing Address
Number and street
( )
( )
City State or country ZIP or Postal code Phone number Alternate phone number
Permanent Mailing Address (if different from current)
Number and street
( )
City State or country ZIP or Postal code Phone number
Date of Birth
/ / Place of Birth
Mo Day Year City State or country
Do you wish to be considered for financial aid? Yes No
Are you currently enrolled in classes at Rivier? Yes No
Proposed entrance date: fall
Year
Is English your native language? Yes No If no, have you taken the TOEFL or IELTS English Proficiency exam? Yes No
Ethnic Background (optional):
The information you provide is used for data collection and research only.
Are you Hispanic or Latino? m Yes m No
In addition, do you consider yourself:
m Asian (Including Indian subcontinent and Philippines)
m American Indian/Alaska Native or other native person of the Americas
m Black or African American
m Native Hawaiian or Other Pacific Islander
m White (Including Middle Eastern)
m Other
Have you ever been convicted of a felony that has not been annulled? Yes No
If you answered yes, please attach a separate sheet of paper that provides the date of each conviction, the name of the state and the specific court where
the conviction was entered, and the acts leading to the conviction.
Office of Graduate Admissions, Rivier University • 420 South Main Street , Nashua, NH 03060-5086

Application rivier.edu/PsyD
| Doctor of Psychology
Previous Higher Education
Please list all colleges and universities you have attended from earliest to most recent. Official transcripts must be requested
for each and submitted directly to the Office of Graduate Admissions or electronically from the school to psyd@rivier.edu.
1. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
2. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
3. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
4. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
5. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
6. ______________________________________________________________________________________________________________________
School name City State (or province & country)
__________________________________________________________________________ /_________________________________/________
Subject/major Degree earned Date entered mo/yr Last attended mo/yr.
If you have attended additional schools, please include them on a separate sheet.
International Applicants
Any applicant who is not a citizen or a permanent resident of the US, is required to submit additional documents in order for
Rivier University to complete an I-20 document for your F-1 Student Visa application. These include a Letter of Financial Support
and TOEFL/IELTS English language proficiency test scores. All foreign transcripts must be evaluated by an approved evaluation
agency and submitted to Rivier University. Detailed requirements for these items are available at www.rivier.edu.
Office of Graduate Admissions, Rivier University • 420 South Main Street , Nashua, NH 03060-5086

Graduate Record Exam (GRE)
Applicants are required to provide scores from the following four GRE tests taken within the last five years for
1) Verbal Reasoning, 2) Quantitative Reasoning, 3) Analytic Writing, and 4) the Psychology subject test.
Test details are available at http://www.ets.org/gre
I have taken the GRE already: Yes No Date Taken: _____________/__________
mo/yr
I plan to take the GRE on: _____________/__________
mo/yr
Recommendations
________________________________________________________________________________________________________________________
Name
Title
________________________________________________________________________________________________________________________
Relationship to applicant
Email address
________________________________________________________________________________________________________________________
Name
Title
________________________________________________________________________________________________________________________
Relationship to applicant
Email address
________________________________________________________________________________________________________________________
Name
Title
________________________________________________________________________________________________________________________
Relationship to applicant
Email address
Application Fee
Please include a check payable to Rivier University for $100 with this application.
My signature below indicates that all information on this application and other documents submitted as part of the application are factual, complete, is my own work, and
is presented honestly. Withholding information requested or giving false information may make me ineligible for admission. I also understand that the documentation I
submit becomes property of Rivier University and will not be returned.
Applicant’s signature
Date
In compliance with federal Clery Act legislation, Rivier University makes the Annual Security and Fire Safety Report available online at www.rivier.edu/ps.
The Office of Graduate Admissions, Rivier University, 420 South Main Street, Nashua, NH 03060-5086
Phone: (603) 897-8219 | psyd@rivier.edu | www.rivier.edu/admissions/graduate
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