We are currently accepting applications for entry into the program for fall quarter The deadline for priority consideration is March 15, 2014.

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MACP 8/13 Thank you for your interest in Bastyr University’s graduate program in counseling psychology. Emphasizing whole-person

wellness and healing, the program embodies a fresh approach to mental health counseling that is grounded in health psychology. You have taken the essential first step on a path that can lead to a rewarding career in the field of counseling. At Bastyr you will be part of a community that understands the role of mental health in the totality of human health. We are currently accepting applications for entry into the program for fall quarter 2014. The deadline for priority consideration is March 15, 2014.

Successful submission of an online application includes the following: • Application forms with all sections completed.

• A personal statement in response to questions included in application packet. • A current resume.

• Two letters of recommendation attached to the enclosed forms, mailed directly from those making the referrals, at least one of whom must be a current or former professor.

• Official transcripts mailed directly from all schools or universities previously attended (international students please refer to the international student policy for directions).

• A $75 non-refundable application fee, made payable to Bastyr University in U.S. funds (check or money order only) Once all of the above items have been received, the admissions committee will review your file. You will hear from us once this review is complete. Please keep us informed of any changes in your contact information. If you have additional questions or need further assistance, please contact the Admissions Office at 425.602.3330 or by e-mail mastersadvise@ bastyr.edu. It is strongly advised that all students speak with an admissions advisor prior to applying. Again, we appreciate your interest in our MA in Counseling Psychology program and look forward to reviewing your application for the incoming class of 2014.

Sincerely yours,

Lauren Schoen

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MACP 8/13

Fall 2014 UNIVERSITY aPPlICaTION

Last Name First Middle Former Name(s)

Mailing address

Address City State Zip

Permanent address (if different) Phone ( )

Address City State Zip

Please type or print.

(Please complete application on other side.)

Date Birthdate (M/D/Y) SS# Male

XXX-XX-

Female

Degree PrOgrAMS (Check one program only.)

Doctor of Naturopathic Medicine

❍ First Year/New Student

❍ Advanced Standing/Transfer (add’l $75 evaluation fee req’d) ❍ Post-Baccalaureate (preparatory)

Doctor of acupuncture & Oriental Medicine

Master of arts in Counseling Psychology Master of Science

Acupuncture

❍ Combined Bachelor/Master in Acupuncture Acupuncture & Oriental Medicine

❍ Combined Bachelor/Master in Acupuncture & Oriental Medicine

❍ Graduate Level Transfer (add’l $75 evaluation fee req’d)

Please attach photograph here. ( Required for international students,

optional for others)

Have you previously applied to Bastyr University? Yes No

If Yes Year: Program Are you currently enrolled? Yes No Emergency contact: Name

Address

Daytime phone Relationship

U.S. Citizen Yes No Perm resident #

A-Birthplace Visa type

Country of Citizenship Describe yourself by checking one:

American Indian/Alaskan Native Black/African American White/Caucasian

Asian American /Pacific Islander Hispanic Other

List all universities and colleges in order of attendance. If still enrolled, indicate leaving date. (If more than six, please attach separate sheet.)

Institution/City/State Dates Attended mo/yr to mo/yr Degrees earned Major Year

________________________________________________ from ________ to _________ ______________ _______________ ____ ________________________________________________ from ________ to _________ ______________ _______________ ____ ________________________________________________ from ________ to _________ ______________ _______________ ____ ________________________________________________ from ________ to _________ ______________ _______________ ____ ________________________________________________ from ________ to _________ ______________ _______________ ____ ________________________________________________ from ________ to _________ ______________ _______________ ____

Master of Science continued

Ayurvedic Sciences Midwifery ❍_{Combined Bachelor/Master in} Midwifery Nutrition ❍_{Post-Baccalaureate (preparatory)}

Bachelor of Science with Major in:

Exercise Science & Wellness Health Psychology

Herbal Sciences

Integrated Human Biology

Nutrition For Office Use Only

Student ID (Office Use Only)

Home phone ( ) Cell phone ( ) E-mail Last 4 digits 14500 Juanita Drive Ne Kenmore, Washington 98028-4966 Tel. (425) 602-3330 Fax (425) 602-3090 www.bastyr.edu

Are you a veteran or current member of the US armed services?

Yes No

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MACP 8/13

PagE 2

Have you ever been licensed as a health care provider? Yes No If yes, please describe on separate sheet.

Has disciplinary action in writing, or of any sort, ever been taken against you by a health care institution, professional association or licensing/certification board? Yes No If yes, please attach explanation on separate sheet.

Are there any complaints currently pending against you before any of the above bodies? Yes No If yes, please attach explanation on separate sheet. Have you ever had any malpractice actions filed against you? Yes No If yes, please attach explanation on separate sheet.

Have you ever been convicted of a felony? Yes No If yes, please attach explanation on separate sheet.

Have you ever been put on probation, suspended, terminated or asked to resign by a graduate or internship training program, practicum site or employer? Yes No If yes, please attach explanation on separate sheet.

Note: Students enrolled in degree programs that include clinical training will be subject to a criminal history background check before entering the

clinical portion of their program. Certain convictions may limit or block clinical participation.

List two persons (three required for midwifery applications), not friends or relatives, who will be sending letters of recommendation (professional colleagues, professors, advisors, employers). (Note: Undergraduate applicants to BS/MSAOM, BS/MSMW and all graduate applicants are required to submit letters.)

Name Occupation/relationship

Name (Third required for midwifery applicants only) Occupation/relationship

If you have consulted a member of the Bastyr University staff or faculty regarding your admission, please list contact names here: What are the different ways you heard about Bastyr University? Check all that apply:

Bastyr University website friend health care provider workshop/event direct mail/flyer newspaper insert ad specify publication(s) _____________________________ other website-please specify ___________________

other ________________________________

Please list other programs/colleges/universities to which you are applying: How do you plan to finance your education (List amounts or percentages)

Financial aid programs _____________ Family ___________ Savings ____________ Work _____________ Other (specify) ___________________________________________________________________________________ Do you plan to apply for financial aid? Yes No

My official transcripts and letters of recommendation (if required) are being forwarded directly to the Bastyr University office of admissions. I certify that the information in this application is complete and correct to the best of my knowledge. I have enclosed my non-refundable application fee. I am aware that deliberate falsification of any admissions information or documents is grounds for rejection or dismissal from Bastyr University.

Signature Date

Bastyr University is an equal opportunity institution. We do not discriminate in matters of employment or participation in programs, services or benefits on the basis of gender, race, creed, color, religion, national origin, age, sexual orientation, gender identification, individuals with disabilities or veterans’ status. Our programs, services and facilities are accessible to individuals with disabilities. Please contact the University in advance if you require special accommodation due to a disability.

Have you: (Please check.)

Completed and signed this application form?

enclosed a check for the $75 (grad & combined Bachelor/Master)/$60 (undergrad) application fee? requested official transcripts be sent from institutions listed in your application?

Attached current resume? Attached completed essay?

Listed names of persons who will write recommendations for you? (See above.)

requested financial aid forms directly from the Bastyr University financial aid office 425.602.3329. Mail materials to: Bastyr University

Admissions Office 14500 Juanita Drive Ne Kenmore, WA 98028-4966

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MACP 8/13

MASTER OF ARTS IN COUNSELING PSYCHOLOGY

PROgRaM aPPlICaTION

Name: _______________________________________________________________

(Last, First, Middle)

Address: _______________________________________________________________________________ In addition to completing the university application and submitting official transcripts (sent directly to Bastyr from the college or university), you must complete the following program-specific application.

Please answer the narrative questions. You may answer each question individually, or combine your answers into one essay. In total, you should write between 1,000 and 2,000 words, which is about 2-4 single-spaced pages.

Narrative Questions

1. What are your career objectives and professional goals?

2. How will a program in Master of Arts in Counseling Psychology help meet these goals? 3. Please discuss your reasons for choosing this program.

4. What additional personal or professional information would be helpful in evaluating your application? Include the factors that led you to this course of study or career choice, any clinical or counseling experience you have had, as well as more general background data.

5. Please tell us where and when you have completed an introductory psychology course with a grade of B (3.0) or better. If you have not yet completed this course, please let us know when and where you plan to complete it. 14500 Juanita Drive Ne Kenmore, Washington 98028-4966 Tel. (425) 602-3330 Fax (425) 602-3090 www.bastyr.edu

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MACP 8/13

MASTER OF ARTS IN COUNSELING PSYCHOLOGY

Applicant’s Name: ____________________________________________________

Part l. The Master of Arts in Counseling Psychology program at Bastyr University is an accredited, stand-alone two-year graduate program leading to eligibility to become a licensed mental health counselor (LMHC). We ask that you address, in a separate letter, the following areas:

1) How long and in what capacity you have known this applicant.

2) Academic skills and/or performance of the applicant in the capacity you are familiar that would contribute to the applicant’s success in graduate school.

3) Personal attributes that would facilitate training and working in the psychology field. 4) Ability to make long-range goals and to persevere in stressful situations.

Part ll. In the rating chart below, please evaluate the applicant in comparison with other students/employees you have known during your professional career.*

excellent Very good Average Below Average N/A Intellectual ability __________ __________ __________ __________ __________ Compassion and caring attitude __________ __________ __________ __________ __________ Work/study skills __________ __________ __________ __________ __________ Interpersonal skills __________ __________ __________ __________ __________ Communication skills __________ __________ __________ __________ __________ Critical thinking skills __________ __________ __________ __________ __________ Resourcefulness

and initiative __________ __________ __________ __________ __________ Emotional maturity __________ __________ __________ __________ __________ Time management skills __________ __________ __________ __________ __________ Stress management skills __________ __________ __________ __________ __________ Potential for contributions

to the field __________ __________ __________ __________ __________ *N/A indicates “not applicable” to knowing the person in the capacity stated

In comparison to all other students/employees you have known, please place an X on the line ranking this applicant on a scale of most capable to least capable.

Most capable ________________________________________________________________ Least capable Referee’s signature ______________________________________________ Date __________________ referee’s name (Please print) ___________________________ Current title/position _________________ Institution or agency _____________________________________________ Phone _________________ Address _______________________________________________________________________________ City/State/zip ___________________________________________________________________________

lETTER OF RECOMMENDaTION aND

aPPlICaNT RaTINg FORM

14500 Juanita Drive Ne

Kenmore, Washington 98028-4966 Tel. (425) 602-3330

Fax (425) 602-3090 www.bastyr.edu

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MACP 8/13

MASTER OF ARTS IN COUNSELING PSYCHOLOGY

TO THe APPLICANT

Please complete the top section of this form and give a form to each person you have asked to write a letter of recommendation for you. references should be returned to the admissions office by March 15. You might

find it helpful to provide your referees with return envelopes, addressed to Bastyr University.

I understand that this is a confidential letter of recommendation, solicited for the sole purpose of evaluating an application for admission to Bastyr University and its programs. I understand that this letter of

recommendation will not be made available to me and will be destroyed should I be admitted and matriculate as a student at Bastyr University. I understand that the University will not forward letters or copies of letters to me, to the referee or to anyone outside the University.

Applicant’s signature ________________________________________________________ Date ____________________________

Name of applicant (please print) ________________________________________________ Address ________________________________________________

City/State/Zip ____________________________________________

Phone ___________________________ E-mail ___________________________

TO THe reFeree

Please complete this form and return it with a separate reference letter to the admissions office on or before March 15. Thank you for taking the time to provide a recommendation for this applicant.

Return to: Bastyr University Admissions Office 14500 Juanita Drive Ne Kenmore, WA 98028-4966

This is a confidential letter of recommendation. Letters of recommendation will not be made available to the applicant and will be destroyed should the applicant be admitted and matriculate as a student at Bastyr University. Title IX of the Education Act of 1972 prohibits discrimination in admission on the basis of marital or parental status. We, therefore, request that, in order to prevent such discrimination, you not include such information in your letter of recommendation.

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