Masters Program in School and Clinical Psychology Supplementary Form

Please print off, fill out and submit with the general department application checklist and other supporting documents.

Name: _____________________________________________________________________________

A. Undergraduate Degree: ___________________________ University: _________________________

GPA (last 60 credits* of undergraduate coursework): _________________________________________
GPA (21 credits of undergraduate psychology and/or educational psychology coursework): ___________

B. At least 21 credits of undergraduate coursework in psychology and/or educational psychology. List courses below.

If more space is required, please fill out on a separate attachment.

C. Please describe on an attached page any practical experience you may have in the application of psychology. Be specific about start and end dates, name of placement or agency, the nature of population and population concerns dealt with, number of hours spent on site, number of hours of supervision received (if applicable), name(s) of supervisor(s), etc.

*University of Alberta credits. 3 credits represents one single-term course (approx. 39 hours of instruction). 60 credits represents 20 single-term courses.

_{^{The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act to determine eligibility for admission to a course or courses in the Department of Educational Psychology. Questions regarding the collection or use or disclosure of this information should be addressed to the Associate Chair, Department of Educational Psychology, Room 6-102 Education North, University of Alberta, Edmonton, AB, T6G 2G5, Phone: (780) 492-5245.}}