Demographic Information

The information below is optional.  It is requested for statistical purposes only and will be kept confidential.

Gender:

Ethnicity:

PGSP practices a nondiscrimination policy regarding physical ability, gender, age, race, color, lifestyle, national and ethnic origins in admission, employment, and in the administration of its program and activities.

The PGSP - AIGLÉ program

A JOINT PROGRAM WITH THE PACIFIC GRADUATE SCHOOL OF PSYCHOLOGY IN PALO ALTO, CALIFORNIA, AND THE AIGLÉ FOUNDATION IN BUENOS AIRES, ARGENTINA

Personal Information

Current Contact Information:

Permanent Address (if different)

Citizenship

Professional Interests

While you will discuss these items in greater detail in your professional statement, please summarize the following information:

Potential area of concentration during clinical training:

Potential area of concentration in research studies:

Educational Background

List all colleges attended since high school and all degrees conferred. If you do not have a degree, indicate the total number of units completed at each college. If you are currently working towards a degree, please indicate the degree you expect to earn,and the expected date, in parentheses. If you participated in an exchange program while attending one of the listed institutions, please do not list that program separately.

Recommendations

Please list below the names and addresses of the three persons from whom you have requested a recommendation.  These references should be able to speak to your ability and/or potential for both research and clinical work.  Whenever possible they should be faculty members in psychology or practicing professional in psychology.

Submission Area

I understand that official transcripts of credit earned at other institutions and other documents which have been presented for admission or evaluation become the property of PGSP and are not returned to the applicant.

I certify that the information recorded in this application, the transcripts provided, and all other application materials submitted are correct and complete.  By submitting this application, I agree to abide by and be subject to the rules and regulations at PGSP.