Ponce Health Sciences University is accredited by: Council of Education of the Commonwealth of Puerto Rico (CE) Middle States Commission on Higher Education (MSCHE) Liaison Committee on Medical Education (LCME) American Psychological Association (APA) Council on Education for Public Health (CEPH) APPLICATION FOR ADMISSION Doctoral Program in Biomedical Sciences (PhD) Doctoral Program in Clinical Psychology (PsyD • PhD-Psy) Doctor of Public Health in Epidemiology (DrPH) Master in Public Health (MPH) General • Epidemiology • Environmental Master of Sciences in Medical Sciences (MSMS) Master of Science in School Psychology (Neuropsychology/Neuroscience of Learning) Professional Certificate in Family & Couples Therapy Postgraduate Certificate in Neuroscience of Learning BS Nursing DEADLINES TO APPLY: PhD Biomedical Sciences ð April 15 Clinical Psychology ð March 15 Public Health ð May 30 Master of Science in Medical Sciences ð May 30 Master of Science in School Psychology ð June 15 Certificate Family & Couples Therapy ð June 15 Certificate in Neuroscience of Learning ð June 15 Bs Nursing ð June 15 Procedure to apply: • Please retain this instruction page for your records. • Print clearly and complete all items on the application. • Keep a photocopy of your completed application form and other materials you submit. Application materials may not be returned or duplicated for personal use. • You must notify the Admissions Office of any changes in your address, e-mail and phone numbers. Please provide the following documents with your application: • Three letters of recommendation (form provided) from college professors or individuals familiar with your professional work and skills. Must be sent directly to the Admissions Office by the concerned professors or individuals. If applying for the Professional Certificate in Family & Couples Therapy, only two letters are required. • Official transcript (in English) from all universities attended. Must be mailed directly to the Admissions Office by the concerned university. • Official scores of professional tests: GRE - for admission to the Doctoral Program in Biomedical Sciences and Doctor of Public Health GRE or EXADEP – for admission to the Doctoral Program in Clinical Psychology (PsyD & PhD-Psy) GRE, EXADEP or MCAT - for admission to the Master in Public Health For official scores & information visit: GRE & EXADEP www.ets.org, MCAT www.aamc.org • Copy of professional license - for admission to the Professional Certificate in Family & Couples Therapy only. • US $83.00 non-refundable application fee - Check or MO payable to Ponce Health Sciences University • Certificate of No Penal Record “Certificado Negativo de Antecedentes Penales”
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PonceHealthSciencesUniversityisaccreditedby:CouncilofEducationoftheCommonwealthofPuertoRico(CE)
MiddleStatesCommissiononHigherEducation(MSCHE)LiaisonCommitteeonMedicalEducation(LCME)
AmericanPsychologicalAssociation(APA)CouncilonEducationforPublicHealth(CEPH)
APPLICATIONFORADMISSION
DoctoralPrograminBiomedicalSciences(PhD)DoctoralPrograminClinicalPsychology(PsyD•PhD-Psy)
DoctorofPublicHealthinEpidemiology(DrPH)MasterinPublicHealth(MPH)General•Epidemiology•Environmental
MasterofSciencesinMedicalSciences(MSMS)MasterofScienceinSchoolPsychology(Neuropsychology/NeuroscienceofLearning)
ProfessionalCertificateinFamily&CouplesTherapyPostgraduateCertificateinNeuroscienceofLearning
BSNursing
DEADL INES TO APPL Y :
PhDBiomedicalSciences ðApril15ClinicalPsychology ðMarch15PublicHealth ðMay30MasterofScienceinMedicalSciences ðMay30MasterofScienceinSchoolPsychology ðJune15CertificateFamily&CouplesTherapy ðJune15 CertificateinNeuroscienceofLearning ðJune15BsNursing ðJune15
Proceduretoapply:
• Pleaseretainthisinstructionpageforyourrecords.• Printclearlyandcompleteallitemsontheapplication.• Keepaphotocopyofyourcompletedapplicationformandothermaterialsyousubmit.Applicationmaterials
maynotbereturnedorduplicatedforpersonaluse.• YoumustnotifytheAdmissionsOfficeofanychangesinyouraddress,e-mailandphonenumbers.
Pleaseprovidethefollowingdocumentswithyourapplication:
• Three letters of recommendation (form provided) from college professors or individuals familiarwith yourprofessionalworkandskills.Mustbe sentdirectly to theAdmissionsOfficeby the concernedprofessorsorindividuals. If applying for the Professional Certificate in Family & Couples Therapy, only two letters arerequired.
• Official transcript (in English) from all universities attended.Must bemailed directly to the Admissions Office by the concerneduniversity.
• Officialscoresofprofessionaltests: GRE-foradmissiontotheDoctoralPrograminBiomedicalSciencesandDoctorofPublicHealth GREorEXADEP–foradmissiontotheDoctoralPrograminClinicalPsychology(PsyD&PhD-Psy) GRE,EXADEPorMCAT-foradmissiontotheMasterinPublicHealth Forofficialscores&informationvisit:GRE&EXADEPwww.ets.org,MCATwww.aamc.org• Copyofprofessionallicense-foradmissiontotheProfessionalCertificateinFamily&CouplesTherapyonly.• US$83.00non-refundableapplicationfee-CheckorMOpayabletoPonceHealthSciencesUniversity• CertificateofNoPenalRecord“CertificadoNegativodeAntecedentesPenales”
APPLICATIONFORADMISSION
Pleaseselectacademicprogramdesired:
qDoctoralPrograminBiomedicalSciences(PhD)
qDoctoralPrograminClinicalPsychologyqPsyDqPhD-Psy
qDoctoralPrograminPublicHealth-Epidemiology(DrPH)
qMasterinPublicHealth(MPH)qGeneralqEpidemiologyqEnvironmental
qMasterofSciencesinMedicalSciences(MSMS)
qMasterofSciencesinSchoolPsychology
qProfessionalCertificateinFamily&CouplesTherapy
qPostgraduateCertificateinNeuroscienceofLearningqBSNursing
Forofficialuseonly
ApplicationFee:Typeofpayment:Datereceived:Deposit:Typeofpayment:
Datereceived:
PERSONAL&CONTACTINFORMATION
LastNameMother’sMaidenLastNameFirstNameMiddleName
SocialSecurityNumber Emailaddress
PermanentHomeAddress City State ZipCode
CurrentMailingAddress(ifdifferent)
CellPhone HomePhone
Emergencycontact:Name Relationship Phonenumber
Father’sName Occupation
Mother’sName Occupation
MaritalStatusqMarriedqSingleqDivorced
Spouse’sName
Spouse’sOccupation
DateofBirth Birthplace Age GenderqMqF
AreyouaUSveteran?qYesqNo
IfnotUScitizen,countryofcitizenship
TypeofVISA
EDUCATIONALHISTORY
(Bachelor,Master,MD,etc.-ListinChronologicalOrder)
PROFESSIONALEXAMINATIONSEXAM DATE SCORE VERB QUAN ANAL WRIT MATH ENGL PHYS BIOEXADEP GRE MCAT
NameofInstitutionsAttended Dates DegreeAwarded&Major DateDegreeAwardedFrom To
Name&locationofHighSchool GraduationDate qPrivateqPublic
NewMCAT
CPFBS CARS BBFLS PSBFB
CollegeBoard
KNOWLEDGEOFLANGUAGES
Academichonors:Researchworkandpublications/PosterPresentation:Communityserviceand/orvolunteerwork:
PROFESSIONALWORKEXPERIENCE
Name&addressofemployer PositionorJobTitle DateofEmployment
Yearsatpresentposition Totalyearsofprofessionalexperience
LANGUAGES READING WRITING SPEAKINGGood Fair Poor Good Fair Poor Good Fair Poor
SPANISH(Compulsory)
ENGLISH(Compulsory) Other
FOROURSTATISTICS
Pleaseindicateyourethnicity(yourresponsewillbekeptconfidentialandwillprovidedatatothefederalgovernmentincompliancewiththeTitleVIoftheCivilRightsActof1964):qHispanicqWhite,non-HispanicqBlack,non-HispanicqAsianorPacificIslanderqAmericanIndian/AlaskanNativeqOtherAreyouafirstgenerationcollegestudent?qNoqYes
Howdidyouhearaboutus?qRecruiterqFriendqWebsiteqFacebookqNewspaperadqOtherPLEASEREADANDSIGNIcertifythatall theinformationIhavesuppliedinthisapplicationistrueandcomplete. Iunderstandthatfalsifyingand/or giving incorrect information in this application may be considered for denial of admission or, if admitted,immediatesuspensionfromPonceHealthSciencesUniversity.IpromisetoabideandrespectthenormsandregulationsofPonceHealthSciencesUniversity. IunderstandthatalldocumentssubmittedforadmissionpurposeswillbecomepermanentpropertyofPonceHealthSciencesUniversity.Applicant’sSignature Date
Applicationsforadmissionareconsideredonthebasisofeachapplicant’squalificationswithoutregardto
race,color,gender,creed,politicalorsexualorientation,nationalorigin,ageorhandicap.PonceHealthSciencesUniversityreservestherightofadmission.
Rev05/16
PERSONALSTATEMENTExplainyourinterestingraduatestudiesandyourlong-rangeprofessionalplans:(ifnecessary,youmayattachanadditionalpage)IcertifythatIamtheauthorofthisPersonalStatement.Iunderstandthatfalsifyingand/orplagiarizingisconsideredunethicalandmayresultindenialofadmissionorsuspensionfromPonceHealthSciencesUniversity.
Signature Date
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