BC MHC Application Summary Factsheet

Please print legibly and include with your application to the Program.

             BROOKLYN COLLEGE MENTAL HEALTH COUNSELING PROGRAM FACTSHEET


                                             Date Application Filed __________________


                  Name  ______________________________________________________________
  APPLICANT
                  Email ______________________________________________________________
 INFORMATION
                  Phone ______________________________________________________________



                  Previous Undergraduate Institution _________________________________

   NAMES OF       Overall GPA ____________
   PREVIOUS
 INSTITUTIONS
    & GPAs        Previous Graduate Institution ______________________________________

                  Overall GPA ____________



                  Undergraduate Degree (e.g., BA, BS) ____________

                  Major __________________________________________
   DEGREE(S)
EARNED & MAJORS
                  Graduate Degree (e.g., MA, PhD)     ____________

                  Major __________________________________________



                  Verbal       ____________
  GRE SCORES
                  Quantitative ____________
(if available)
                  Writing      ____________



                  Introductory Psychology                        ____________
   RELEVANT
COURSE GRADES     Abnormal Psychology or Psychopathology         ____________

(**if graduate-   Developmental Psychology or Child Development  ____________
level course,
mark with "G")    Psychology Statistics                          ____________



RELATED WORK OR VOLUNTEER/INTERNSHIP EXPERIENCE(S)

Position or Activity                         Organization (City, State, Dates) 

_________________________________________    _________________________________________

_________________________________________    _________________________________________

_________________________________________    _________________________________________
Department of Psychology · 2900 Bedford Avenue, Brooklyn, NY 11210-2889 · Phone: (718) 951-5601
MHC Program inquiries email: bcMHCp@gmail.com
Director: Gregory A. Kuhlman, Ph.D. · Deputy Director: Prof. Rona Miles