Contact:
CDER Rehabilitation Counseling Program
c/o Interwork Institute
San Diego State University
3590 Camino del Rio North
San Diego, CA 92108-1716
Phone: 619-594-6115
Fax: 619-594-0991
E-mail: libsack@mail.sdsu.edu
Linda Libsack-Schmalzel
Before you complete this application, please prepare a 1 page (400-600 words) personal summary, including a discussion of your professional goals as they apply to your reasons for seeking admission to the Rehabilitation Counselor Program. Please prepare your personal summary in a word processing software. You will copy and paste your personal essay into a field at the end of this application.
Notes for screen reader users: Thorough out this page, you will need to fill out various input fields. Once you fill out one input field in the Forms mode, you will need to turn off the Forms mode and read the instructions for the next input field. You can turn off the edit mode by hitting the + (plus) key on the number keypad on the right side of the keyboard.
Required* -- You will be unable to send this form without filling in the Required Fields
* Indicate below the program to which you are applying. (Required) Select One Master of Science in Rehabilitation Counseling Selected Courses for Professional Certification (CRC, DMEC, etc.)
* Please indicate your planned source of tuition support. (Required) Select one I will pay my tuition. My employer will pay my tuition. I would like to apply for support from RSA grant funds. Other:
If other, please identify:
Title: Select One Mr. Mrs. Ms.
*Last name: required field(Required)
*First name: required field(Required)
Middle name:
Previously used last name:
Mailing Address:
*Street: required field(Required)
Additional (Apt. Unit.,etc.):
*City: required field(Required)
*State: required field(Required)
*Zip Code: required field(Required)
Note: valid format for the phone number is xxx-xxx-xxxx
*Phone 1: required field (example: 555-555-5555)(Required) * Type: Home/Cell/Work required field: Select One Home Work Cell (Required)
Phone 2: (example: 555-555-5555) Type: Home/Cell/Work: Select One Home Work Cell
Phone 3: (example: 555-555-5555) Type: Home/Cell/Work: Select One Home Work Cell
*Email 1: required field(Required)
Email 2:
Employer:
Street:
Additional (Apt. Unit. Suite,etc.):
City:
State:
Zip Code:
*Legal Resident (State or Country): required field(Required)
Ethnicity (Optional):
*I have access to an Internet-ready computer for at least four to six hours per week: (Required) Select One Yes No
I am concerned about accessibility of the program faculty and course materials, and I would like to discuss confidentially with a student advisor: Select One Yes No
Compute on four-point scale with A = 4, B = 3, C = 2, D = 1
*Undergraduate GPA: required field(Required)
Post baccalaureate GPA:
No. of postgraduate units:
Note: GRE is not required if you have a master's degree already, or if you are not going to seek a master's degree through SDSU or UNT.
Date Taken (valid format is month/date/year):
Scores:
Verbal:
Quantitative:
Total:
If not completed, date exam is scheduled to be taken (valid format is month/date/year):
Please solicit letters of recommendation from three (3) persons who are acquainted with your interpersonal skills, academic background, employment potential, and/or work or volunteer experience. There is no recommendation form used; simply ask the persons writing letters for you to send them directly to the contact below:
CDER Rehabilitation Counseling Programc/o Interwork Institute San Diego State University 3590 Camino del Rio North San Diego, CA 92108-1716 Phone: 619-594-6115 Fax: 619-594-0991 E-mail: libsack@mail.sdsu.edu Linda Libsack-Schmalzel
If you are a practicing vocational rehabilitation counselor with a state VR agency, and you will be applying to the program as an RSA scholar under federal CSPD grants for the CDER programs, you will need to formally request your employer’s approval to apply for the program (See Student Handbook on CDER website). Additionally, you must be aware of and agree to the provisions of Title 34 of the Code of Federal Regulations, Part 386, which stipulate conditions of receipt of scholarship support for training under the Long-Term Training (LTT) Program. If you apply for that program, you will be provided a copy of the RSA Scholarship Information Manual for review, and you will be required to sign and submit a separate scholarship agreement.
NOTE: This application is for admission to the Rehabilitation Counselor Program Department only. The program will advise you when to formally apply to the University for Graduate Admissions.
This is your page. Use it to supply the Admission Committee with a verbal picture of yourself as a person. Particularly helpful would be a discussion of your professional goals as they apply to your reasons for seeking admission to the Rehabilitation Counselor Program. (Required)
The following item is the verification code. In order to submit your information above, you must enter the verification code given below. The code consists of first 3 numbers and 3 letters totaling 6 characters. Three letters are not case sensitive.
*Your Submission Verification Code is 269PCB. Please remember this code 269PCB and type this into the following text box: required field (Required)