Program Preference Form - University of Nevada, Reno

INSTRUCTIONS:
University of Nevada, Reno
Department of Psychology Program Preference Form
Please complete this document by directly typing in this form. All applicants are required to complete, print, and mail this form to
the Department of Psychology, University of Nevada, Reno. The deadlines for the receipt of this application and all supporting
materials is January 1 (clinical and behavior analysis), and February 1 (cognitive brain science) *Official transcripts, GRE
scores, and Graduate School Application with fee must be sent directly to the University of Nevada Reno, Graduate School M/S
0326 Reno, Nevada 89557-0326*
A. PERSONAL DATA:
1. Name_____________________________________________________________ 2. Male___ Female____
Last First Middle
3. Home Address______________________________________________ City_____________________________
State____ Zip__________ Home Phone_____________________ Contact Phone_________________________
Email______________________________________________________________________________________
4. Undergraduate Institution______________________________________________________________________
Type of Degree, Major, and Date Received________________________________________________________
Undergraduate GPA________________ Psychology GPA_______________ GPA Last 2 Years _____________
5. Graduate Institution __________________________________________________________________________
Type of Degree, Major, and Date Received ____________________________Graduate GPA _______________
6. If you have taken the GRE, please list your scores:
Verbal__________Quantitative_______________Analytical_______________Advanced____________________
If you have not taken the GRE, please indicate the date you plan to take it: ______________________________
(We strongly suggest you take it in October, as the December score sometimes arrives late)
7. Have you authored or co-authored any professional presentations? __________ If yes, provide list when sending
additional supporting materials.
8. Have you authored of co-authored any professional publications? ____________ If yes, provide list when sending
additional supporting materials.
9. Are you a Nevada Resident? Yes No
10. Equal Opportunity, Affirmative Action: The Psychology Department welcomes applications from candidates of
both sexes and from all ethnic groups. Although not required, we encourage you to indicate your ethnic identity:
________________________________________________________________________________________

B. APPLICATION QUESTIONS:
1. When would you like to begin full-time graduate study? ____________________________________________
2. Please indicate your one program preference below:
a. Clinical (Ph.D. only)
b. Cognitive & Brain Science: (1) M.A. only (terminal degree) (2) Ph.D.
c. Behavior Analysis: (1) M.A. only (terminal degree) (2) Ph.D.
3. Please indicate any special interest you have within the field marked above. _____________________________
4. Please rank order the faculty member(s) you are interested in working with for the program you are applying.
BEHAVIOR ANALYSIS: ____Pat Ghezzi _____Linda J. Parrott _____Ramona Houmanfar ______Larry Williams
CLINICAL: ___Melanie Duckworth ____Jane Fisher ____Victoria Follette ____William Follette ____Alan Fruzzetti
____Steven Hayes ____Holly Hazlett-Stevens ____William O'Donohue ____Anthony Papa
COGNITIVE & BRAIN SCIENCE: ____Marian Berryhill ____Gideon Caplovitz ____Michael Crognale
____Jeffrey Hutsler ____Michael Webster ____ Jacqueline Snow ____ Lars Strother
5. Have you applied for admission to this department before? ________________If so, indicate the date _________
6. If you are applying to Clinical or to Behavior Analysis please answer the following question: We realize that your
plans may change after you have been in graduate school, but at this time how would you prefer to be employed
after receiving your degree? (choose only one):
Providing direct services in a private practice setting
Providing direct services in a hospital, community mental health center, or similar institution
A relatively equal mix of direct service delivery and research in some institutional (non-private practice)
setting
Doing primarily research in a hospital, community mental health center, or similar institution
An academic position in a 4-year undergraduate college
An academic position in a university with a graduate program
C.
ADDITIONAL SUPPORTING MATERIALS:
Note: The Department of Psychology requires that you send the following items DIRECTLY to the department,
timed to arrive before January 1 (clinical, behavior analysis) or February 1 (cognitive brain science).
Three letters of recommendation (from instructors or individuals who know your work). Have Recommenders sign
the back seal of the envelope before they return the letter to you for forwarding
Letters of recommendation have been requested from:
Name
Institution
1. ___________________________________________ __________________________________________
2. ___________________________________________ __________________________________________
3. ___________________________________________ __________________________________________
4. (optional) ____________________________________ __________________________________________
On a separate sheet of paper(s) provide a brief statement of purpose for graduate study (e.g. career aims,
professional and research interests and experiences, and why you want to study at UNR).