Master’s in Educational Psychology and

Post-Master’s in School Psychology

A. Please complete application and return to:	How did you hear about our program?
Dr. Joseph F. Kovaleski, Director	____________________________________
Educational and School Psychology Department
Indiana University of Pennsylvania
246 Stouffer Hall	Applications due February 1
Indiana, PA 15705-1087
724-357-3785

B. Send official transcripts and Graduate Record Exam Scores to the Graduate School; advise them that

you are applying for the Master’s or Post-Master’s Program in Educational or School Psychology so

they may send copies to us for review by the Admissions Committee.

C. Name:	Mr.		Date:	________________
	Mrs.	_______________________	Social Security:	________________
Address:	_____	______________________________	____________	______ ______
	(Number)	(Street)	(City)	(State) (Zip)
Telephone:		_______________________
Work Address:	______	______________________________	____________	______ ______
	(Number)	(Street)	(City)	(State) (Zip)
Work Telephone:		____________________________	Email:	________________

D. Previous Academic Training
Name of School	Location	Dates Attended	Date of Degree
_________________________	____________________	____________________	___________
_________________________	____________________	____________________	___________
_________________________	____________________	____________________	___________

E. Undergraduate:		Major:	___________________			Minor:	____________________
Graduate:		Major:	___________________			Minor:	____________________
		Major:	___________________			Minor:	____________________
Number of semester hours of graduate study to date:						________	GPA	___________
GRE Scores:	_________			_________	__________			Date: ____________
	Verbal			Quantitative	Writing

(If additional space is required, please use another sheet of paper.)

F. Membership in professional or collegiate organizations:
____________________________________________________________________________________
____________________________________________________________________________________
Publications, articles, awards:
_____________________________________________________________________________________
_____________________________________________________________________________________
Professional experience:
Position	Location	Date
________________________	____________________________________________	_____________
________________________	____________________________________________	_____________
________________________	____________________________________________	_____________
________________________	____________________________________________	_____________

G. Number of years’ experience in a field related to education or psychology: _____________________

Certificates: _____________________________________________________________________

(Please submit a copy of your certificate – only front face is needed, showing areas of certification.)

Other positions held: ___________________________________________________________________

_____________________________________________________________________________________

H. Give the names and addresses of two qualified persons who gave you recommendations with your

Graduate School application. If they are more than three years old, you must submit new ones. The

following are suggested (not required) job areas from which to choose; emphasis should be placed on

professional assessment:

1. your immediate employer or supervisor

2. university professor in your major field

3. a professional educator familiar with your background and potential in the department program area

I. On a separate sheet of paper, please write a comprehensive response to the question:
1. What professional goals do you hope to achieve by obtaining a master’s degree in educational
psychology or an educational specialist’s certificate in school psychology?
_________________________________	_______________
Signature of Applicant	Date

REMINDER – PLEASE SEND THIS APPLICATION FORM DIRECTLY TO THE

EDUCATIONAL AND SCHOOL PSYCHOLOGY DEPARTMENT.

ALL OTHER MATERIALS ARE TO BE SENT TO THE GRADUATE SCHOOL.