GSEP 2013r3 Application

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YList your academic honors, awards, scholarships, or publications:If applying to education programs, specify all teaching and/or administrative credentials you hold:If applying to education programs, specify all teaching and/or administrative credentials you plan to pursue: (Those applicants pursuing a single-subject credential should specify the major.)Which of the following have you taken?GRE – Graduate Record Exam (within the last five years):Subject Test: psychology (Psy.D. applicants only)General Test: verbal quantitative analytical writingMAT – Miller’s Analogy Test: within the last two years within the last five years GMAT – Graduate Management Admissions Test (within the last five years) CBEST – California Basic Education Skills Test Subject Matter Competence Test: CSET SSAT/Praxis None of the above Applying for GRE/MAT waiverIf you answered “None of the above,” which do you plan to take?Date:List persons whom you have asked to write letters of recommendation:List any members of the Pepperdine facultyou have corresponded:List any Pepperdine alumni with whom you have corresponded:Applicants may be invited for an oral interview and asked to demonstrate writing skills. This is a requirement for some programs. Reputation of SchoolConference AttendeeOther (please specify): Direct MailGrad Fair Attendee Online AdvertisementPrint Advertisement Alumni/Student ReferralInternet SearchWhere h ave you seen or heard advertising for the Graduate School of Education and Psychology or its programs? (Please check all that apply.) RadioInternet NewspaperKioskDid you attend an Information Meeting or have a personal consultation? MagazineOther (please specify): Yes NoI certify that to the best of my knowledge, the information furnished in this application is true and complete. I agree that if such information, or any other information uponwhich my admission is based, is not true or complete, the University may revoke my acceptance, dismiss me from the program, and/or rescind my degree. I further agree that, ifadmitted, I will abide by the rules and regulations of the University including, but not limited to, those rules contained in the current University catalog. I acknowledge that allranscripts which I forward to the University become the property of the University and will not be forwarded to another institution nor returned to me.XApplicant’s SignatureDatePepperdine University does not unlawfully discriminate on the basis of race, color, national or ethnic origin, religion, age, sex, disability, orprior military service in the administration of its educational policies, admission, financial aid, educational programs, or activities.7

PEPPERDINE UNIVERSITY GRADUATE SCHOOL OF EDUCATION AND PSYCHOLOGYWAIVER AND TRANSFER CREDIT PETITIONDirections:1. Carefully read the policies section below.2. Complete this petition form and submit it, and the appropriate documents with your application for admission.3. New students will receive official notification by mail shortly after receiving admission to the University. Continuingstudents will be officially notified by mail shortly after the petition is evaluated.P OL IC IESWaiver:A waiver satisfies a course’s content requirements without fulfilling its unit requirements. Any courses taken elsewhere, which astudent wishes to be considered for waiver, must adhere to theseguidelines: Course work must have been completed at a regionallyaccredited institution. A grade of “B” or higher must have been attained. Course work must have been completed within the pastseven years. Unless proven equivalent, extension and continuingeducation courses and partial credit will not be considered.Psychology – only certain Pepperdine courses are eligiblefor waiver:PSY: 626, 656, 657, 658, 659CLP: 657, 659 Education – Each situation is assessed on an individual basis.Students beginning the teaching credential program in residence.No waivers or transfer credits will be allowed.UNIT CREDIT TOWARD A PEPPERDINE DEGREE ISNOT GIVEN IN WAIVER, NOR DO UNITS APPEAR ONTHE PEPPERDINE UNIVERSITY TRANSCRIPT WHEN ACOURSE IS WAIVED.Documents needed for waiver petition:1. Petition form.2. Photocopy of catalog course description.3. Official transcript, if not on file.Transfer credit:Transfer credit fulfills the master’s or doctoral level unitsneeded to complete degree requirements. Any coursestaken elsewhere, which a student wishes to be consideredfor transfer credit, must adhere to the following guidelines: Only doctoral-level courses may be petitioned for transfertoward the doctorates in education and psychology. Course work must have been completed at a regionallyaccredited institution. Only graduate level courses taken after the completion ofa bachelor’s degree may be considered. A grade of “B” or higher must have been attained. Course work must have been completed within the past sevenyears. Course content must approximate that of the program inwhich the applicant is enrolled. Extension, continuing education, and undergraduate coursesas well as partial credit will NOT be considered. A maximum of 6 semester units may be transferred towardthe master’s; 8 toward the doctorate in education; and 9toward the doctorate in psychology.UNIT CREDIT TOWARD A PEPPERDINE DEGREE ISGIVEN IN TRANSFER AND TRANSFER UNITS APPEARON THE PEPPERDINE UNIVERSITY TRANSCRIPT.Documents needed for transfer credit petition:1. Petition form.2. Photocopy of catalog course description.3. Course syllabus, if requested.4. Official transcript, if not on file.P L E A S E P R I N T OR T Y PEI am petitioning for:( ) Waiver( ) Transfer credit( ) Both waiver and transfer creditNameDaytime Telephone NumberMailing addressCityStateZip codeList courses for consideration as they appear on the transcript. (Use additional paper if necessary.)COURSE NO.COURSE TITLEINSTITUTIONPEPPERDINE COURSE TITLE AND NUMBER REQUESTED FOR WAIVER/TRANSFERXSignatureDateI am a: ( ) New student – send form and attachments with the application for admission in the envelope provided to the office of admissions.( ) Continuing student – send form and attachments in the envelope provided to your student services administrator.8

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YTRANSCRIPT REQUESTApplicant: Mail this form and appropriate transcript fees to the registrar of the college or university you attended.To the registrar - Name of Institution:Please forward a copy of the transcript forMaiden (If applicable)FirstLast NameStreetCityMiddleStateI last attended classes during:Zip CodeSocial Security No.Term / YearSignaturePlease attach this form to the transcript and mail to the following address:Office of Admissions, Pepperdine UniversityGraduate School of Education and Psychology6100 Center Drive, 5th FloorLos Angeles, CA 90045-1590TRANSCRIPT REQUESTApplicant: Mail this form and appropriate transcript fees to the registrar of the college or university you attended.To the registrar - Name of Institution:Please forward a copy of the transcript forMaiden (If applicable)FirstLast NameStreetCityMiddleStateI last attended classes during:Zip CodeSocial Security No.Term / YearSignaturePlease attach this form to the transcript and mail to the following address:Office of Admissions, Pepperdine UniversityGraduate School of Education and Psychology6100 Center Drive, 5th FloorLos Angeles, CA 90045-1590TRANSCRIPT REQUESTApplicant: Mail this form and appropriate transcript fees to the registrar of the college or university you attended.To the registrar - Name of Institution:Last NameStreetPlease forward a copy of the transcript forMaiden (If applicable)FirstCityI last attended classes during:MiddleStateZip CodeSocial Security No.Term / YearSignaturePlease attach this form to the transcript and mail to the following address:12.085 (07-08)Office of Admissions, Pepperdine UniversityGraduate School of Education and Psychology6100 Center Drive, 5th FloorLos Angeles, CA 90045-1590139

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YRECOMMENDATIONANSWER ALL QUESTIONS AS COMPLETELY AS POSSIBLE. PLEASE PRINT OR TYPE.Name of ApplicantProgram Code (pg. 8)DateThe Family Educational Rights and Privacy Act of 1974 provides permission for a matriculated student to have access to his or her file unless a waiver of that right has beensigned. If you wish to waive your right to have access to your file, sign your name in the space provided. If you do not sign, you will be permitted to inspect this reference only ifyou enroll at the Graduate School of Education and Psychology.In the event that I become a student at the Graduate School of Education and Psychology, I hereby waive my right of access to this letter of recommendation.Applicant’s SignatureXDateHow long have you known the applicant?In what capacity?Compared to individuals you have known at a similar level of development, please evaluate the applicant on each factor listed below:SuperiorTop 2%Very GoodTop 10%GoodTop 25%AverageMid 50%Below AverageLow 25%Unable ToJudgeAcademic AbilityCreativityWritten CommunicationOral CommunicationClinical Aptitude (applicants for psychology programs only)Interpersonal RelationsMaturityMotivationEthicsPotential to Complete Degree/CredentialOVERALL RATINGComment on the applicant’s potential as an education or psychology professional (attach additional pages if necessary).NameInstitution / EmployerPositionAddressCity, State, ZipTelephone NumberEmailSignatureXPLEASE RETURN THIS FORM TO:DatePepperdine University O ce of AdmissionsGraduate School of Education and Psychology6100 Center Drive, 5th Floor, Los Angeles, CA 90045-159010

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YRECOMMENDATIONANSWER ALL QUESTIONS AS COMPLETELY AS POSSIBLE. PLEASE PRINT OR TYPE.Name of ApplicantProgram Code (pg. 8)DateThe Family Educational Rights and Privacy Act of 1974 provides permission for a matriculated student to have access to his or her file unless a waiver of that right has beensigned. If you wish to waive your right to have access to your file, sign your name in the space provided. If you do not sign, you will be permitted to inspect this reference only ifyou enroll at the Graduate School of Education and Psychology.In the event that I become a student at the Graduate School of Education and Psychology, I hereby waive my right of access to this letter of recommendation.Applicant’s SignatureXDateHow long have you known the applicant?In what capacity?Compared to individuals you have known at a similar level of development, please evaluate the applicant on each factor listed below:SuperiorTop 2%Very GoodTop 10%GoodTop 25%AverageMid 50%Below AverageLow 25%Unable ToJudgeAcademic AbilityCreativityWritten CommunicationOral CommunicationClinical Aptitude (applicants for psychology programs only)Interpersonal RelationsMaturityMotivationEthicsPotential to Complete Degree/CredentialOVERALL RATINGComment on the applicant’s potential as an education or psychology professional (attach additional pages if necessary).NameInstitution / EmployerPositionAddressCity, State, ZipTelephone NumberEmailSignatureXPLEASE RETURN THIS FORM TO:DatePepperdine University O ce of AdmissionsGraduate School of Education and Psychology6100 Center Drive, 5th Floor, Los Angeles, CA 90045-159011

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YRECOMMENDATIONANSWER ALL QUESTIONS AS COMPLETELY AS POSSIBLE. PLEASE PRINT OR TYPE.Name of ApplicantProgram Code (pg. 8)DateThe Family Educational Rights and Privacy Act of 1974 provides permission for a matriculated student to have access to his or her file unless a waiver of that right has beensigned. If you wish to waive your right to have access to your file, sign your name in the space provided. If you do not sign, you will be permitted to inspect this reference only ifyou enroll at the Graduate School of Education and Psychology.In the event that I become a student at the Graduate School of Education and Psychology, I hereby waive my right of access to this letter of recommendation.Applicant’s SignatureXDateHow long have you known the applicant?In what capacity?Compared to individuals you have known at a similar level of development, please evaluate the applicant on each factor listed below:SuperiorTop 2%Very GoodTop 10%GoodTop 25%AverageMid 50%Below AverageLow 25%Unable ToJudgeAcademic AbilityCreativityWritten CommunicationOral CommunicationClinical Aptitude (applicants for psychology programs only)Interpersonal RelationsMaturityMotivationEthicsPotential to Complete Degree/CredentialOVERALL RATINGComment on the applicant’s potential as an education or psychology professional (attach additional pages if necessary).NameInstitution / EmployerPositionAddressCity, State, ZipTelephone NumberEmailSignatureXPLEASE RETURN THIS FORM TO:DatePepperdine University O ce of AdmissionsGraduate School of Education and Psychology6100 Center Drive, 5th Floor, Los Angeles, CA 90045-159012

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YSTATEMENT OF RESPONSIBILITY Teaching CredentialProviding I am accepted into Pepperdine University’s Graduate School of Education and Psychology, I hereby makethe following statement and acknowledge that I fully understand the rules, regulations, and policies regarding myeligibility to enroll and remain in the Teaching Credential Program for the purpose of obtaining a teaching credential.a) I must have completed a baccalaureate or higher degree from a regionally-accredited college or university;b) I must maintain a cumulative grade point average of 3.0 in all work completed in the program in order to graduate;c) To remain eligible, I must accept full responsibility to maintain the academic program standards as stated in thePepperdine University Graduate School of Education and Psychology academic catalog;d) I must complete the Commission’s Certificate of Clearance (COC) application and submit verification of atuberculosis (TB) test to the Credential Office prior to my first term of classes, or at the very latest, prior toregistration for Clinical Experience 1 coursework. .I understand that if I hold or have held a Certificate of Clearance (COC), California Teaching Credential, PreIntern or Intern Certificate, or Emergency Teacher Permit, I must submit verification of the credential document(expired or current) to the Credential Office in lieu of the COC application.e) I am aware that course work pertaining to the U.S. Constitution is a requirement for a Preliminary TeachingCredential, and that I may satisfy this requirement by passing a Commission-approved college or university exam, orby submitting a transcript which verifies completion of an approved college course.f) I further acknowledge that I am required to take the Literacy Theory and Methods for Multiple Subject Candidatesand pass the RICA (Reading Instruction Competence Assessment) to be recommended for my first Multiple SubjectTeaching Credential. Due to the nature of the content of the RICA examination, I understand that it is stronglyrecommended that I complete the literacy coursework prior to taking the RICA examination.g) I understand the Subject-Matter Competence Policy:Prior to beginning student teaching, teacher candidates must take and pass the state-approved subject-mattercompetence examination — California Subject Examination for Teachers (CSET) – to establish subject-mattercompetence.I understand that subject-matter competence (CSET) and passage of the CBEST or its equivalent must be verifiedprior to student teaching.Multiple-subject credential students must take the state-approved subject-matter competence examination (CSET) forMultiple Subject teaching to establish subject-matter competence.Single-subject credential students have two methods of establishing subject-matter competence:a. The student must pass the state-approved subject-matter competence examination (CSET) for the specific subjectORb. The student must complete a commission-approved subject-matter program at a California college or universityand obtain a subject-matter statement letter (verification of completion) from the authorized person in theeducation department at the university or college.h) I understand that test dates such as CBEST and CSET may fall on a weekend class meeting, in which case, releasetime will not be granted.I also understand that passage of subject-matter competence before starting the MAE/TP program is necessary tocomplete a one-year program.13

P E P P E R D I N E U N I V E R S I T Y G R A D UAT E S C H O O L O F E D U C AT I O N A N D P S YC H O LO G YP e P P e r d i n e U n i v e r s i t y G r a d Uat e s c h o o l o f e d U c at i o n a n d P s yc h o lo G yi) I understand the Residency Policy:Residency Policy: To be recommended for a teaching credential, students are required to complete all course workat Pepperdine University, once admitted to the program.STATEMENT OF RESPONSIBILITY Administrative Services CredentialFor all students:Human Deve

UC United Church of Christ UM United Methodist OC Other Christian NO None OT Other UD Undeclared NOTE: Information regarding ethnicity, age, and religious preference are used for statistical purposes only and not in the determination of eligibility for admission. GSEP 2008 Application