Application to the Doctorate in Clinical Psychology

Most Recent School Attended

School Name

Level of Study

Attended Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

Additional Schools

School #2 Name

Level of Study

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

School #3 Name

Level of Study

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

School #4 Name

Level of Study

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

School #5 Name

Level of Study

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Degree Obtained?

Disciplinary Questions

Have you previously been dismissed from any academic program or university?

Yes

Please explain the situation:

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

Yes

Please explain the situation:

Program Course Requirements

The Hawaii School of Professional Psychology at Chaminade University of Honolulu requires applicants to successfully complete, five undergraduate (with a C or better) or graduate (with a B or better) courses that serve as a basic foundation for coursework in clinical psychology. Foundation courses must be completed prior to starting the program. Several of these courses serve as direct prerequisites to the PsyD program courses. The following undergraduate or graduate courses are required:

Introduction to psychology or general psychology (this course may be waived if the applicant has completed a Bachelor's or Master's degree in Psychology)
Abnormal psychology, psychopathology, or maladaptive behavior
Statistics or research methods
Two additional courses in the field of psychology

Have you completed the required foundation course requirements? Applicants can still apply with outstanding foundation course requirements. Course must be completed prior to starting the PsyD program.

Yes

Unsure

Signature

I acknowledge that every school that I have attended may release all requested records and recommendations to Chaminade University of Honolulu. I also understand that employees at CUH may confidentially contact my current and former schools should they have questions about the information submitted on my behalf.

I certify that all information submitted in the admission process, including this application and any other supporting materials, is my own work, factually true, and honestly presented, and that these documents will become the property of Chaminade University of Honolulu and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be false.

I agree to notify the institutions to which I am applying immediately should there be any change to the information requested in this application, including disciplinary history.

I understand that once my application has been submitted it may not be altered in any way; I will need to contact Chaminade University of Honolulu directly if I wish to provide additional information.

I understand that all offers of admission are conditional, pending receipt of official final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I have read and agree to the above.

Applicant Signature

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