Faculty of Social and Behavioural Sciences

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FACULTY OF SOCIAL AND BEHAVIOURAL SCIENCES

APPLICATION FOR ADMISSION TO THE PH.D. (CLINICAL PSYCHOLOGY) COURSE

FOR 2017 (First Year of Intended Enrolment)

Applications Close: 31st October, 2016 by 12 noon.

TitleLast NameGiven Names
(Dr/Mr/Ms/Mrs/Mr)

Previous Name

I wish to undertake this course: Full-time Part-time * Part-time means half-time

Please Note: This course is only offered on an Internal basis.

Country of birthYear of entryMain language

(if not Australia) (to Australia) Spoken at home

Aboriginal or Torres Strait Islander status:

Aboriginal Both Aboriginal and TSI Torres Strait Islander None of the above

Office Use Only:

Student Two: __ / __ /__ Transcripts  Yes  No Entered: __ /__ /__ Offer  Yes  No

Student Advised: __ /__ / __

INSTRUCTIONS FOR COMPLETING THIS FORM

Please fill out this form carefully as it forms an important part of our selection procedure. Applicants must produce a detailed and type-written application. If the application is not type-written, it will not be considered. This form can be downloaded from the School of Psychology web site: Please do not attach a curriculum vitae, but supply the information at the appropriate points on the form. If, however, you have a publications list which exceeds the available space you may attach separate sheets. Please note that boxes to be completed must be kept to the size provided and not enlarged.

It should be noted that entry to the course is very competitive. The number of places offered may vary depending on known resources at the time of selection. Interviews will be granted to a limited number of applicants based on this form, the attached academic transcripts, referees' reports and the in-principle agreement of an INTERNAL academic staff member of the School of Psychology to be a thesis supervisor. The interview is an extremely important aspect of the consideration of an applicant’s suitability for the course. It is important that we are able to contact you between mid-November and the end of February, firstly to arrange interviews (which normally occur late November to early December) and to offer places, and later (January-February) to offer a second round of places for the course should any candidates decline first round offers. If you expect to be away from your usual address at these times please indicate dates and contact details where indicated below. Note that acceptance on the course is valid only for the year indicated above. No deferment of enrolment can be considered.

It is also the responsibility of the applicant to ensure that they give themselves sufficient time to find an internal supervisor before applications are due. Research interests of staff can be found on the School of Psychology web site:

It is the responsibility of applicants to be available to attend an interview and this requirement should be taken into account in making plans during this period. It may be possible to arrange telephone interviews for overseas and interstate applicants. However, South Australian applicants are expected to attend in person. If you are in any doubt, please contact the Course Coordinator prior to finalising your arrangements.

Attachments, apart from those requested, will be removed before the application is given to the selection committee.

Applicants for the PhD (Clin. Psych.) who are graduates with psychology degrees from non-Australian universities must have their qualifications assessed by the Australian Psychological Society for equivalence to an Australian programme of study prior to submitting their application. Information about the process for obtaining this assessment can be found on the APS web site If you did not complete both secondary and tertiary education in Australia or in a country where English is considered the first or native language, you will need to demonstrate English language skills at IELTS (International English Level Testing System) academic level 7 and achieve the required minimum score of 7 in each component of the IELTS academic module. This is a requirement by the Psychology Board of Australia (PsyBA), with further details found at

IMPORTANT DATES

October 31st 2016Applications close / Last day for referee reports submission

Late November 2016Invitation of formal interview to short-listed applicants

Late November 2016Formal interviews conducted

Early December 2016Formal offers to successful candidates

Applicants who are offered a place on the Ph.D. (Clin Psych) program must undertake a criminal history check. Confirmation of the offer is dependent on a satisfactory criminal history clearance consistent with PsyBA’s requirement that the criminal history check contains no offences that would result in a person being declared unfit to practice. The PsyBA also requires that students are registered as provisional psychologists with the Board on entry into the program. Students will also need to comply with SA Health’s Immunisation and Blood-Borne Viruses Policy. This is a SA Health Policy Directive requirement for students prior to undertaking clinical placements. The detailed written procedure required for provisional registration and criminal history checks, and proof of immunisation status will be given to those students who are offered a place on the program. Please note that students are responsible for costs associated with provisional registration, criminal history checks, and immunisations.

Personal Details

If you will be away between mid-November and late-February, please indicate contact details below(including

Dates):

Did you complete Year 12(or its equivalent) in Australia? Yes No

If Yes, in which state/territory? And in which year?

ACADEMIC QUALIFICATIONS (List all your academic qualifications beyond high school):

Institution

Name of Course

Year Begun

Year Completed*

Degree & Date Conferred(e.g. Bachelor, Masters, PhD)

Overall percentage mark for your Honours year%

Level that 1st Class Honours is awarded at your institution80% / 85% / other / NA (please circle)

*NB If you withdrew from a course without completing it, write ‘withdrawn’.

CURRENT ACADEMIC ENROLMENT (Indicate your current degree and year/level of any University courses)

Institution

Year/Level

Transcripts showing results in all subjects, including failures, must be attached by all applicants, including Flinders graduates. The transcript submitted with the application can be unofficial, but an official or certified copy of all transcripts must be presented if you accept an offer into the course. Applications without transcripts will NOT be processed. Please include a grading key (usually found on back of official transcript).
Applicants who have completed Honours must include the percentage mark for their Honours year on Page 3 of this application form.

International applicants must send official transcripts with their applications.

Students who are completing degrees/courses in the current year should submit final results as soon as they are known.

If some results are not yet available, we may wish to contact your home institution. Please indicate the name of the contact person who can supply your results and the date that they will be available. (Flinders University students are not required to provide contact details).

Contact Name:

Email Address:

Date Results Expected to be Available:

THESES COMPLETED (Or presently undertaken)

Title

Are you a registered psychologist with the Psychology Board of Australia? Yes No

If “Yes” how many years have your been registered __

(Details of registration or licensure in other countries can be provided separately.)

MEMBERSHIP OF PROFESSIONAL SOCIETIES/ASSOCIATIONS

(e.g., Australian Psychological Society, Australian Association for Cognitive Behaviour Therapy, etc.)

DETAILS OF EMPLOYMENT

Organisation

Position or Title

CONTENT OF EMPLOYMENT (except Research – please see next page)

Please describe the content of any paid employment which you have listed above and which involved activities relevant to the area of psychology. Do not attach additional sheets, nor enlarge box.

RESEARCH ACTIVITIES

Please indicate any research activities (other than theses/dissertations) in which you have been involved. (Publications can be listed in a later section.) Do not attach additional sheets nor enlarge box.

OTHER KINDS OF EXPERIENCE (Such as voluntary work, etc.)

In each case, please indicate how long you have been/were involved in the activity and estimate your hours per week of involvement. Do not attach additional sheets nor enlarge box.

PROPOSED THESIS TOPIC

In the space provided, please give details of possible thesis topic(s) to be pursued in the Ph.D. (Clin. Psych.) program. Ensure that you have discussed these ideas with the supervisor and that they have given in-principle agreement to supervise you. Final allocation of students to supervisors will occur after admittance to the program, taking account of student and supervisor preferences. Please consult the School website for research interests and contact details of potential supervisors ( A list of possible research projects is also available on this web site. Supervision is NOT limited to staff who teach in the clinical program. However, the primary supervisor must be an internal academic member of the School of Psychology.

Supervisor (insert name of School of Psychology staff member):

has given in-principle agreement to supervise me if I am admitted Yes No

I am also applying for a Scholarship Yes No

I am also applying for a regular Ph.D. Yes No

If yes, specify here who has agreed to supervise you for this.

Name of Supervisor:

AREAS OF INTEREST

Please indicate areas of clinical psychology in which you have a particular interest and where you might seek employment. Do not attach additional sheets nor enlarge box.

Outline your REASONS for applying for this course. Do not attach additional sheets or enlarge box.

PUBLICATIONS

Please list any publications which you have produced (Do not enlarge box. Attach extra sheets if necessary).

REFEREE REPORTS

Two CONFIDENTIAL referees reports are required, at least one of which should be from an academic referee. The other may be from a person who has observed you and your work in a non-academic context. These reports should reach the University by 31st October, 2016. Please give each of your referees a copy of the attached referee’s form.

Referee 1

Referee 2

DECLARATION

Part-time candidates should be aware that they need to be available for coursework and/or placement activites 2.5 days per week throughout the period of candidature. Thus, the part-time course is no less than half-time. Applicants will need to be able to demonstrate to the Selection Committee that they can devote sufficient time to their studies in order to complete the degree within the standard time limit. A person who is employed on a full-time basis would not be able to meet this requirement, even if enrolled part-time. The lodgement of a signed application form implies an agreement to undertake the course according to the time commitments described above.

In signing this application form:

I have attached all relevant transcripts and I understand that action on this application may not be taken if any of the information and transcripts have not been supplied

I understand and agree to the time commitments as described above.

Icertifythattothebestofmyknowledgealldocumentation andinformationsubmittedormadeavailablebymetothe University,whetherinrelationtoanycourseofstudyorotherwise,istrue,accurateandcomplete. Iacknowledgethatthe provisionofinaccurateorincompleteinformationbymyself,oracertifyingauthority,mayresultinthewithdrawalofanyoffer ofenrolment,orthecancellationofanyenrolmentallowedonthebasisofacceptanceofthatoffer. Iconsenttothe collection,storageanddisclosureofinformationrelatingtorecordfalsificationorotherirregularactsinaccordancewith UniversitiesAustraliaprocedures. IauthoriseFlindersUniversitytoobtainfromothereducationalinstitutionsdetailsofmy enrolmentandacademicrecordatthoseinstitutions.

I understand that an offer of a place on the program is not confirmed until I have obtained a satisfactory criminal history clearanceand provided official, or certified, copies of all academic transcripts.

SignatureofApplicant Date

Giving false or misleading information is a serious offence under the Criminal Code (Commonwealth).

For Full-time applicants only:

Although I have indicated a preference for full-time enrolment, this is dependent upon obtaining a scholarship

Yes No

If I do not obtain a scholarship, I would wish to undertake the program on a part-time (half-time) basis.

Yes No

LODGING YOUR APPLICATION AND ACADEMIC TRANSCRIPTS

When completed by Australian applicants, this form and copies of all academic transcripts should bescanned and emailed as one pdf document to .

When completed by international applicants, this form, an authorised copy of all academic transcripts and an APS letter of equivalency should be forwarded to the International Office, Flinders University, GPO Box 2100, Adelaide SA 5001.

The application must arrive no later than 31st October, 2016 by 12 noon.