Doctoral Course Work Check Sheet For Psychologist Form - Alaska Board Of Psychologist And Psychological Associate Examiners
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1
2
3STATE OF ALASKA
BOARD OF PSYCHOLOGIST AND PSYCHOLOGICAL ASSOCIATE EXAMINERS
DOCTORAL COURSE WORK CHECK SHEET FOR PSYCHOLOGIST
Dear Applicant:
To assist the board in their review of your course work, please complete the following form and return it with your
application. Thank you for your assistance in this matter.
NAME OF APPLICANT:
UNIVERSITY/COLLEGES ATTENDED:
TYPE OF DEGREE:
DATE GRANTED:
NOTE: Please have all of your undergraduate and graduate transcripts forwarded to the division directly
from your school(s). If course titles do not clearly reflect the subject matters listed, the applicant must
include course syllabi/descriptions of courses in which the material was covered.
1.
Was your graduate program APA approved (i.e., full/provisional) at
the time of graduation? .......................................................................................................
Yes
No
If answer is no, answer question 2 (a-h).
2.
All of the following requirements must be met to establish equivalency.
a. Regionally accredited ..............................................................................................
Yes
No
b. Public identification as Psychology program...........................................................
Yes
No
c. Psychology program is coherent organizational unit ..............................................
Yes
No
d. Clear authority for Psychology program ..................................................................
Yes
No
e. An identifiable core of full-time Psychology faculty .................................................
Yes
No
f.
Identifiable body of students....................................................................................
Yes
No
g. The Psychology program is an organized, integrated sequence of study..............
Yes
No
h. Equivalent of three full-time years, graduate study
A.
Two years at a single institution, from which the doctoral degree is granted; and
B.
One year is in full-time residence from the institution from which the degree
is granted? (See 12 AAC 60.083(a)-(b).)......................................
Yes
No
3.
All applicants must complete question 3 (1-11):
Instruction in:
1. Scientific and professional ethics/standards ...................................................
Yes
No
COURSE
DATES
CREDIT
INSTITUTION
NUMBER
FULL COURSE TITLE
FROM / TO
HOURS
08-4113c (Rev. 6/00)
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