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DEPARTMENT OF PSYCHOLOGY APPLICATION FORM 2019 (intake 2020)

Applied Master’s Programme in Clinical / Counselling Psychology Dear Applicant Thank you for your interest in furthering your studies at the University of the Free State, and in particular at the Department of Psychology. The attainment of a qualification in Clinical or Counselling Psychology will enable you to register as a psychologist with the Health Professions Council of South Africa (HPCSA). Our programme aims at preparing you academically, personally and professionally for such a career. All the necessary information to complete this application is obtainable from the Selection Information booklet on the Psychology website.

IMPORTANT: The application form is a fillable PDF document. Please contact us if you require any assistance with the application process.

Dr MJ Kometsi Programme coordinator: Clinical Tel: +27 51 4012889, kometsimj@ufs.ac.za

Dr. NF Tadi Programme coordinator: Clinical Tel: +27 51 4019313, tadinf@ufs.ac.za

Dr J Jordaan Programme coordinator: Counselling Tel: +27 51 4012890, jordaanj1@ufs.ac.za

Ms Elize du Plessis Programme Administrator Tel: +27 51 4019420, duplesse@ufs.ac.za

IMPORTANT DATES: CLOSING DATE: 28 JUNE 2019 SUBMISSION OF FINAL MARKS: 17 JULY 2019 RESULTS OF PAPER SELECTION: 29 JULY 2019 SUBMISSION OF AUTOBIOGRAPHY: 5 AUGUST 2019 SELECTION WEEK: 19-23 AUGUST 2019

Incomplete documents or late applications (closing date 28 June 2019), will not be considered.

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1. IDENTIFYING PARTICULARS:

1.1 Surname

1.2 First names (including preferred name)

1.3 ID number

1.4 Age

1.5 Postal Address

1.6 Telephone number/s 1. 2.

1.7 E-mail

1.8 Current occupation

1.9 Gender Male Female Other

1.10 Ethnicity Black White Coloured Asian Other

1.11 Disabled Yes No

1.12 If you answered “Yes” to Question 1.11 please describe the nature of your disability

APPLICATION DOCUMENT 2019

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1.13 In which category (you may only mark one) do you apply ? CLINICAL COUNSELLING

IMPORTANT: MOTIVATE YOUR CHOICE:

1.14 Have you previously applied at this University for this programme? YES NO

IF YES, WHEN (WHICH YEAR/S)?

1.15 Please indicate your language proficiency in terms of reading, writing, speech and comprehension. Refer to the languages that you are proficient in. Mark with an X.

Language Read Write Speech Comprehension Good Average Poor Good Average Poor Good Average Poor Good Average Poor

English Afrikaans Sesotho IsiZulu Xhosa Other:

2. ACADEMIC QUALIFICATIONS:2.1 Universities attended

University Degree obtained Year

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2.2 Undergraduate Psychology modules

It is COMPULSORY to attach a certified copy of your undergraduate academic record.

2.3 Postgraduate qualifications

Complete the following table. This is COMPULSORY. A certified copy of your postgraduate academic record must be attached. PLEASE NOTE: If you are currently busy with your postgraduate qualification and do not have any module marks available when completing this application, it is expected of you to send a certified copy of your half year marks to the Department as soon as possible, but not later than 22 July 2019. Please give an indication whether you are still awaiting final marks.

Awaiting final marks: YES NO

University Degree Psychology Honours Module name Module Year Final subject %

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3. CONSENT FORM:

I Surname

Name

1. Give consent to participate in the selection procedure for the Master’s programme in Clinical andCounselling Psychology offered by the University of the Free State.

2. Understand and accept the following:a. The reasons for the selection procedure;b. The criteria employed during the selection procedure;c. The nature of the selection procedure;d. How the decisions of the selection panel will be implemented.e. The decision of the panel is final.

3. Understand and accept that it is my responsibility to:a. Bring barriers to learning1 to the attention of the Department before the selection

procedure commences;b. Ensure that I submit complete and accurate application documents.

4. Am aware that I may contact Mrs Elize du Plessis at +27 51 401 9420; or e-mail:duplesse@ufs.ac.za to verify the completeness of my application documents.

5. Give permission that personal information as provided by me, may be made available to themembers of the selection panel.

6. Accept that the Department is unable to explain all aspects of the selection procedure before theprocedure commences.

I hereby declare that all information provided in this application is correct and truthful.

DATE:

1 Barriers to learning include (but are not limited to) the following: concentration, eyesight, hearing, language problems (comprehension, reading, spelling, writing), motor problems, symptoms of medical illnesses, side-effects of medication, consequences of recent hospitalisation or psychological/psychiatric problems.

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4. REFEREES:

Although it is not a requirement of the University of the Free State to submit referee reports, we do require the names of two people who will be able to verify certain information should it be necessary.

1. Name of person

Relationship

Number of years known

Telephone number

2. Name of person

Relationship

Number of years known

Telephone number

5. FEEDBACK:

The Department strictly adheres to specific procedures when selecting the new intake of students. The decision of the Department with regard to the success of an application is final and binding. If your application was unsuccessful, no correspondence will be entered into by the Department with any associates, family members or acquintances whatsoever. Upon completion of both the paper selection and interview processes each prospective candidate will receive an official email with the final result. This will serve as the only form of feedback.

Thank you for your application!

Dr. MJ Kometsi, Dr. NF Tadi & Dr. J Jordaan

IMPORTANT: You have now completed the Selection Form for the Applied

Master’s Programme in Psychology. Please proceed to completing the UFS Postgraduate

Application Form. Take note of the supporting documents that should be included.

PLEASE CLICK ON SUBMIT AFTER YOU HAVE COMPLETED BOTH FORMS

Inspiring excellence. Transforming lives. Inspireer uitnemendheid. Verander lewens.

T: +27 51 401 3000 | E: info@ufs.ac.za | www.ufs.ac.za

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CAMPUS

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PICK A BRIGHT FUTURE WITH US

APPLICATION FORMPOSTGRADUATE STUDIES

General information

Admission is subject to the condition that you comply with the admission requirements of the University of the Free State. In addition,where applicable the admission will be subject to departmental approval.

A copy of the following must accompany this form on submission:

• Study record (Academic transcript) with certificate of conduct and/or qualification certificate if you have obtained yourdegree

• Identity document of applicant• Passport document (International students)• SAQA Evaluation Certificate for applicants with foreign qualifications• Where applicable, students should attach the departmental selection form (before you apply you need to contact the

relevant department for more information)You will only be recognised as a registered student if you have REGISTERED during the registration period to the specified schedule.Supporting documents not submitted in time could prevent an applicant from registering as well as from being placed in a residence(where applicable).

Disclaimer: The University of the Free State reserves the right, in its sole and absolute discretion, to withdraw your application to theUniversity, should the attached results, documentation and/or information requested in terms of this form, be found to be erroneousor fraudulent.

For closing dates, please inquire with the relevant department.

Checklist

Academic Transcript with certificate of conduct and/or qualification certificateif you have obtained your degree

Supporting Documents Applicant checklist Office use

RECEIVED AND CHECKED:

STAFF NO:

Identity document of applicant

Passport (International students only)

Departmental selection form (where applicable)

SAQA Evaluation Certificate for applicants with foreign qualifications

Please do not photocopy 1 Version 4/April 2019

Personalinformation

Contactinformation

Academiccareer

Tertiaryinformation

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1.2 Home language

Afrikaans

English

isiNdebele

isiZulu

Sesotho

Sepedi

Setswana

Tshivenda

Xitsonga

isiXhosa

siSwati

Other

1.3 Contact details in case of emergency

Email:

Title:

Names:

Surname:

Relationship:

2 3 4

Example: +27 72 123 4567Contactnumber: 2 7 7 2 1 2 3 4 5 6 7

Type on form or complete in block letters and black ink

STUDENT NUMBER If you are already in possession of a UFS student number

1.1 Applicant details

Title:

Full names as theyappear on yourID/Passport:

ID number if South African:(Citizen or permanent resident)

African Asian Coloured White Other

Surname:

DDate of birth:

D M M Y Y Y Y

Race

Gender: Male Female

D DM MY Y

Section A | Application

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2.1 Physical address

Unit Number:

Complex Name:

Street Name:

Suburb/District:

City/Town:

Country:

Street Number:

Postal code:

2.2 Postal address

Suburb/District:

City/Town:

Country:

Postal code:

Postal Service: PO Box Private Bag

Number:

1.5 Details of citizenship (international applicants only)

Citizenship:

Passport issue date:

Passport number:

Passport expiry date:

Place of issue:

D D M M Y Y Y Y D D M M Y Y Y Y

1.4 Disability support

Same as above

Personalinformation

Contactinformation

Academiccareer

Tertiaryinformation

1 2 3 4

Identity number:(If applicable)

Visual impairment Deaf/hearing impairment Physical impairment Learning impairment

Please specify any assistance that would be needed:

Yes NoWould you like the support of the Center for Universal Access and Disability Support?

If yes, please specify type of disability

Other:

Disability date: D D M M Y Y Y Y

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2.3 Applicant contact information

Cellphone number: NB: SMS messages will be sent to this number

PrimaryEmail address:

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Telephone number: Home: or Work:

Personalinformation

Contactinformation

Academiccareer

Tertiaryinformation

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3.1 Academic programme for which application is being made

Bloemfontein Campus Qwaqwa Campus South CampusCampus:

Honours Master’s Doctorate PG Diploma Other

If Other, specify:Field of studyspecialisation:

Faculty to which you wish to apply

Economic and Management Sciences Education Health Sciences Law

Natural and Agricultural Sciences Humanities Theology

3.2 Starting semester

First Semester Second Semester

3.3 Campus residence placement

Yes NoDo you require housing on the campus?

3.4 Financial assistance

Yes NoDo you require financial aid? If yes, see details belowTo apply for an NRF bursary, complete the NRF application on the NRF website: https://nrfsubmission.nrf.ac.za/nrfmkii/Other funding opportunities for postgraduate applications can be found on the UFS website: www.ufs.ac.za, if you click on"Postgraduate School"

4.1 What are you currently doing?

Post-school college

University of Technology (Technikon)

Enrolled in a foreign secondary education institution

Employed

Gap year

University

Unemployed

Other/Specify:

*All communication will be sent to this email address

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4.2 Tertiary information

Personalinformation

Contactinformation

Academiccareer

Tertiaryinformation

1 2 3 4

Have you ever been prohibited from continuing with your studies at any University / University of Technology (Technikon) / College?

Yes No

If yes,which insitution

1.

2.

3.

Degree / Diploma Year obtained Student number

Y Y Y Y

Y Y Y Y

Y Y Y Y

Applicants must provide copies of the qualifications obtained, transcripts of marks (containing a list of the student's grades in the subjectsstudied) and certificates of conduct.

Applicants with foreign qualifications must provide SAQA Evaluation Certificate. For more information onthe verification of qualifications, please visit www.saqa.org.za.

1.

2.

3.

Indicate the name of the previous University / University of Technology (Technikon) / College, where you obtained your qualification:

Indicate qualifications from previous University / University of Technology (Technikon) / College.

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Please read this carefully before signing.

I, the applicant, hereby:

(a) declare that all information in this document is true and correct.

(b) grant permission to the University of the Free State to enquire about and verify my qualifications already obtained, or any otherinformation entered on this application form.

(c) voluntarily provide the University of the Free State with the information contained in this document, and consent to the Universityof the Free State -

• collecting this information, and• processing this information to enable the University of the Free State to consider and process my application.

(d) acknowledge that in the event that my uploaded documents and/or information, as contemplated in clause (c) above, are foundto be fraudulent, the University of the Free State reserves its right, in its absolute and sole discretion, to withdraw my admissionto the University of the Free State.

(e) acknowledge that the University is not under any obligation to accept me as a student, and that admission to the University is theprerogative of the applicable University selection office under which my studies will fall.

(f) acknowledge that I am submitting this application freely and voluntarily. If I am a legal minor, I confirm that my legal guardian/parentis fully aware and supportive of my application to this institution.

(g) understand that acceptance of my application does not obligate me to study at this institution, nor does it imply that I am automatically regarded as a student, until I have formally registered as such and have paid the required fees, as stipulated in theUniversity guidelines.

(h) declare and accordingly consent that the UFS shall process my personal information provided herein (as contemplated in termsof the Protection of Personal Information Act 4 of 2013).

Section B | Declaration

Signature of applicant:

Date: D D M M Y Y Y Y

Section C | Confidentiality

The UFS confirms that your personal information will only be used for purposes relating to your potential relationship with the UFS asa student, including but not limited to the processing of your application to study at the UFS, effecting registration at the UFS and forany communication purposes related to your application and/or registration to study at the UFS.

UFS futher confirms that all personal information provided in your application form will be treated confidentially and will not be soldto a third party or used for commercial or related purposes.