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
