Advanced Clinical Assessment and Diagnosis

Application Period

I am applying for:

Enter semester you wish to be admitted.

Year of application

Enter year you wish to be admitted

Registration Information

First Name *

Last Name *

Email *

Confirm Email *

Phone *

Identification Information

Title *

Salutation

Gender *

Enter your gender identification.

Last name or family name *

First Name *

Middle initial

Other name(s) that may appear on your educational records and academic credentials

Date of birth *

Place of birth *

If not USA, country

Citizen status *

Choose one from below:

U.S. Citizen
Permanent Resident
Student Visa

If other, please describe

Street Address (include apartment number) *

City *

State *

Zip Code *

Telephone (area code and number) *

Email address *

Work Telephone

Mobile telephone

Demographic Information

Optional Questions

The following questions are optional, for government reporting purposes only.

Date of birth

Gender

Prefer to self-describe

Country of origin

Please select any group that applies to you (optional).

Please describe

Equal Opportunity

New York University is an affirmative action/equal opportunity institution.

Undergraduate College or University

Name of School *

Date entered *

Date left *

Degree/Diploma *

Graduate School

Name of School *

Date entered *

Date left *

Degree/Diploma *

Special Instructions

In order to process your applications, you must email a copy of your graduate school transcript to Dr. J. Siegel at: js13@nyu.edu.

Certification

Agreement *

I certify that all information, including any supporting documents submitted in this application to NYU Silver School of Social Work, is complete and true to the best of my knowledge and belief. I agree to promptly notify (in writing) the Enrollment Services Office of any changes concerning the information I provide in this application and in any supporting documents. I understand that providing false, misleading, or incomplete information can result in the withdrawal of an offer to register or dismissal as a nonmatriculated student if perjury on the application is discovered. I also understand that I may be dismissed if I fail to maintain satisfactory scholastic standing or violate the School rules of behavior, the NASW Code of Ethics, or the University Rules of Conduct. I understand that this application and all materials received in support of it become the property of New York University and will not be duplicated for me or returned to me for any reason. Furthermore, I understand that New York University reserves the right to deny permission to register, or require the withdrawal of any student at any time for any reason it considers sufficient, including scholarship, character, and personal conduct. I understand that this application may be superseded and that the University reserves the right to alter requirements or change deadlines.

By checking this checkbox, I hereby agree to the terms described above.

Advanced Clinical Assessment and Diagnosis – HBIII