PonceHealthSciencesUniversityisaccreditedby:CouncilofEducationoftheCommonwealthofPuertoRico(CE)

MiddleStatesCommissiononHigherEducation(MSCHE)LiaisonCommitteeonMedicalEducation(LCME)

AmericanPsychologicalAssociation(APA)CouncilonEducationforPublicHealth(CEPH)

APPLICATIONFORADMISSION

DoctoralPrograminBiomedicalSciences(PhD)DoctoralPrograminClinicalPsychology(PsyD•PhD-Psy)

DoctorofPublicHealthinEpidemiology(DrPH)MasterinPublicHealth(MPH)General•Epidemiology•Environmental

MasterofSciencesinMedicalSciences(MSMS)MasterofScienceinSchoolPsychology(Neuropsychology/NeuroscienceofLearning)

ProfessionalCertificateinFamily&CouplesTherapyPostgraduateCertificateinNeuroscienceofLearning

BSNursing

DEADL INES TO APPL Y :

PhDBiomedicalSciences ðApril15ClinicalPsychology ðMarch15PublicHealth ðMay30MasterofScienceinMedicalSciences ðMay30MasterofScienceinSchoolPsychology ðJune15CertificateFamily&CouplesTherapy ðJune15 CertificateinNeuroscienceofLearning ðJune15BsNursing ðJune15

Proceduretoapply:

• Pleaseretainthisinstructionpageforyourrecords.• Printclearlyandcompleteallitemsontheapplication.• Keepaphotocopyofyourcompletedapplicationformandothermaterialsyousubmit.Applicationmaterials

maynotbereturnedorduplicatedforpersonaluse.• YoumustnotifytheAdmissionsOfficeofanychangesinyouraddress,e-mailandphonenumbers.

Pleaseprovidethefollowingdocumentswithyourapplication:

• Three letters of recommendation (form provided) from college professors or individuals familiarwith yourprofessionalworkandskills.Mustbe sentdirectly to theAdmissionsOfficeby the concernedprofessorsorindividuals. If applying for the Professional Certificate in Family & Couples Therapy, only two letters arerequired.

• Official transcript (in English) from all universities attended.Must bemailed directly to the Admissions Office by the concerneduniversity.

• Officialscoresofprofessionaltests: GRE-foradmissiontotheDoctoralPrograminBiomedicalSciencesandDoctorofPublicHealth GREorEXADEP–foradmissiontotheDoctoralPrograminClinicalPsychology(PsyD&PhD-Psy) GRE,EXADEPorMCAT-foradmissiontotheMasterinPublicHealth Forofficialscores&informationvisit:GRE&EXADEPwww.ets.org,MCATwww.aamc.org• Copyofprofessionallicense-foradmissiontotheProfessionalCertificateinFamily&CouplesTherapyonly.• US$83.00non-refundableapplicationfee-CheckorMOpayabletoPonceHealthSciencesUniversity• CertificateofNoPenalRecord“CertificadoNegativodeAntecedentesPenales”

APPLICATIONFORADMISSION

Pleaseselectacademicprogramdesired:

qDoctoralPrograminBiomedicalSciences(PhD)

qDoctoralPrograminClinicalPsychologyqPsyDqPhD-Psy

qDoctoralPrograminPublicHealth-Epidemiology(DrPH)

qMasterinPublicHealth(MPH)qGeneralqEpidemiologyqEnvironmental

qMasterofSciencesinMedicalSciences(MSMS)

qMasterofSciencesinSchoolPsychology

qProfessionalCertificateinFamily&CouplesTherapy

qPostgraduateCertificateinNeuroscienceofLearningqBSNursing

Forofficialuseonly

ApplicationFee:Typeofpayment:Datereceived:Deposit:Typeofpayment:

Datereceived:

PERSONAL&CONTACTINFORMATION

LastNameMother’sMaidenLastNameFirstNameMiddleName

SocialSecurityNumber Emailaddress

PermanentHomeAddress City State ZipCode

CurrentMailingAddress(ifdifferent)

CellPhone HomePhone

Emergencycontact:Name Relationship Phonenumber

Father’sName Occupation

Mother’sName Occupation

MaritalStatusqMarriedqSingleqDivorced

Spouse’sName

Spouse’sOccupation

DateofBirth Birthplace Age GenderqMqF

AreyouaUSveteran?qYesqNo

IfnotUScitizen,countryofcitizenship

TypeofVISA

EDUCATIONALHISTORY

(Bachelor,Master,MD,etc.-ListinChronologicalOrder)

PROFESSIONALEXAMINATIONSEXAM DATE SCORE VERB QUAN ANAL WRIT MATH ENGL PHYS BIOEXADEP GRE MCAT

NameofInstitutionsAttended Dates DegreeAwarded&Major DateDegreeAwardedFrom To

Name&locationofHighSchool GraduationDate qPrivateqPublic

NewMCAT

CPFBS CARS BBFLS PSBFB

CollegeBoard

KNOWLEDGEOFLANGUAGES

Academichonors:Researchworkandpublications/PosterPresentation:Communityserviceand/orvolunteerwork:

PROFESSIONALWORKEXPERIENCE

Name&addressofemployer PositionorJobTitle DateofEmployment

Yearsatpresentposition Totalyearsofprofessionalexperience

LANGUAGES READING WRITING SPEAKINGGood Fair Poor Good Fair Poor Good Fair Poor

SPANISH(Compulsory)

ENGLISH(Compulsory) Other

FOROURSTATISTICS

Pleaseindicateyourethnicity(yourresponsewillbekeptconfidentialandwillprovidedatatothefederalgovernmentincompliancewiththeTitleVIoftheCivilRightsActof1964):qHispanicqWhite,non-HispanicqBlack,non-HispanicqAsianorPacificIslanderqAmericanIndian/AlaskanNativeqOtherAreyouafirstgenerationcollegestudent?qNoqYes

Howdidyouhearaboutus?qRecruiterqFriendqWebsiteqFacebookqNewspaperadqOtherPLEASEREADANDSIGNIcertifythatall theinformationIhavesuppliedinthisapplicationistrueandcomplete. Iunderstandthatfalsifyingand/or giving incorrect information in this application may be considered for denial of admission or, if admitted,immediatesuspensionfromPonceHealthSciencesUniversity.IpromisetoabideandrespectthenormsandregulationsofPonceHealthSciencesUniversity. IunderstandthatalldocumentssubmittedforadmissionpurposeswillbecomepermanentpropertyofPonceHealthSciencesUniversity.Applicant’sSignature Date

Applicationsforadmissionareconsideredonthebasisofeachapplicant’squalificationswithoutregardto

race,color,gender,creed,politicalorsexualorientation,nationalorigin,ageorhandicap.PonceHealthSciencesUniversityreservestherightofadmission.

Rev05/16

PERSONALSTATEMENTExplainyourinterestingraduatestudiesandyourlong-rangeprofessionalplans:(ifnecessary,youmayattachanadditionalpage)IcertifythatIamtheauthorofthisPersonalStatement.Iunderstandthatfalsifyingand/orplagiarizingisconsideredunethicalandmayresultindenialofadmissionorsuspensionfromPonceHealthSciencesUniversity.

Signature Date