Master of Arts in Community Counseling

Personal Information
First Name:
Middle Initial:
Last Name/Surname:
Maiden/Alternate Name:
Mailing Address:
Street Address: (if different from above)
City:
State:		-Select State- -NOT IN US- AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code:
Country:		-Select a Country- United States ------------- Afghanistan Albania Algeria Andorra Angola Antigua And Barbuda Argentina Armenia Aruba Ashmore & Cartier Islands Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan de Nova Island Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Lybia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre & Miquelon Saint Vincent, The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia , S Sandwich Is. South Korea Spratly Islands Spain Sri Lanka Sudan Suriname Svalbard, Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Is. Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And Futuna Islands West Bank Western Sahara Yemen Zambia Zimbabwe
Home Phone:
Cell Phone:
Email Address:
Date of Birth:	-Select Month- January February March April May June July August September October November December -Select Day- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Have you ever been convicted of a felony?		No        Yes
If yes, please explain:
The following information is requested for tracking purposes only and will not affect your application:
Citizenship:		United States       Other than U.S.
Ethnicity:
Are you Hispanic or Latino?		Yes No
Race:		Select Race American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Asian Black or African American White
Gender:		Female       Male
Religious Preference:
How did you hear about Missouri Valley College Graduate Studies?

Indicate that you have fulfilled each requirement for admission
Bachelor's degree
Grade point average
If Bachelor Degree is not in psychology, which of the following classes have you completed? General or Introduction to Psychology Theory of Personality Abnormal Psychology History of Psychology Research Design Physiological Psychology (If you are uncertain whether or not you have had the above classes, leave the box blank and you will be contacted.)
How do you plan to send the following? Please check one for each.
Resume email mail
Personal Statement email mail
I waive my right to view the contents of my letters of recommendation. I understand that my decision to waive my right to review the evaluator comments submitted on this form will not affect the decision of the Admissions Committee.*
I do not waive my right to view the contents of my letters of recommendation. I understand that my decision to review the evaluator comments submitted on this form will not affect the decision of the Admissions Committee.*
*Please note: The Family Education Rights and Privacy Act of 1974 accords admitted students the right to review these recommendation forms unless that right is waived.

Name of Reference        Email
*Applicants must either ask the above references to complete the Reference Letter Form or should send them a printed copy to fill out.
Printable Reference Letter Form (PDF)
Master of Arts in Community Counseling (MACC)
Educational Plans
Entry Year:
Term:	Select Term January Summer August
Do you plan to enroll as:	Select Enrollment Full Time Part-Time
(If international, you must be full-time)
Will you apply for Financial Aid:	Yes No
(*If Yes, must completeFree Application for Federal Student Aidonline.)
Graduate Records Exam
(Official score sheet must be submitted to the Admissions Office. Minimum combined score of 900 required for admission into program; exceptions will be considered on an individual basis.)
Have you taken the GRE?	Yes        No
Score Verbal:
Quantitative:
If you answered No, date you will take the GRE:
Educational History
(Bachelor’s degree from a regionally accredited institution required) All applicants must have official transcripts sent directly to the Missouri Valley College Admissions Office for all college and universities attended. International transcript must be evaluated by World Education Services (wes.org) or another approved outside evaluator.
First Education
Institution:
Location:
Dates Attended:
Degree/Major:
GPA:
Second Education
Institution:
Location:
Dates Attended:
Degree/Major:
GPA:
Third Education
Institution:
Location:
Dates Attended:
Degree/Major:
GPA:
Employment History
Do you plan to hold salaried employment while enrolled?	Yes       No
Will your employer be paying for a portion of your tuition?	Yes       No

International Students
Missouri Valley College requires verification of available funding for International Students by submission of an Affidavit of Support form.  Forms are available online or by contacting the Admissions Office.
Is English your native language? (If no, you must submit TOEFL results)	Yes       No
Have you taken the TOEFL?	Yes       No
If yes, TOEFL score:
If no, date you will take the TOEFL:
Do you now have a visa?	Yes       No
If yes, Visa Type and Expiration Date:

I hereby certify that all information given in this application is complete and accurate to the best of my knowledge.  I understand that intentional omission or falsification of requested information can lead to disqualification or eventual dismissal from the program.
Date:
Name:

This application must be completed in its entirety and submitted to the Missouri Valley College Admissions Office, 500 E. College Street, Marshall, MO 65340. The following must also be submitted: 

• $30 application fee (non-refundable)
• 3 letters of professional reference
• GRE score sheet
• Resume
• Personal Statement
• Final official transcripts sent directly from each institution of higher education you have attended

Once all required documents are received, you will be contacted for a mandatory on-site interview if the documents you provided meet the Admissions standards.

Missouri Valley College does not discriminate on the basis of race, age, gender, color, religion, disability, national or ethnic origin in the recruitment and admission of students.