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					   Application for
    Admission to
the Master of Science
  Graduate Program
               The University of Tennessee
    College of Education, Health, and Human Sciences
           Rehabilitation Counseling Program
             A523 Bailey Education Complex
                Knoxville, TN 37996-3452
                  Phone: (865) 974-8013
                   Fax: (865) 974-0135

            This form is available in alternate formats.
Please contact Dr. Patrick Dunn at 865-974-8013 or
                                    Application for Admission to the
                          Master’s Degree Program in Rehabilitation Counseling

                                    STEPS TO FOLLOW FOR ADMISSION:
 You must apply and be admitted to the Graduate School at The University of Tennessee before you
can be considered for admission to the Rehabilitation Counseling Program. Call, access or write the
Graduate School at:


                                         218 Student Services Building
                                          The University of Tennessee
                                             Knoxville, TN 37996
                                                (865) 974-3251

Complete applications to the Graduate School include the following: (1) completed application; (2) three or
more Graduate Rating Forms; (3) two official transcripts from each college or university attended; (4) $35
application fee and (5) GRE scores. The application and Rating Forms can be found in the current Graduate
School Catalog. Please note that it takes approximately six weeks from test date for GRE scores to be reported
to The University of Tennessee Graduate School.

In addition:
 You must apply to the Department of Educational Psychology and Counseling at The University of
Tennessee before you can be considered for admission to the Rehabilitation Counseling Program. Contact
Julie Harden at the number below for an application.

To be considered for admission to the Graduate Program in Rehabilitation Counseling, the information
requested in Parts I and II (pps. 3 & 4) of this document must be completed typed or printed clearly –
illegible applications will be returned.

Please complete and return Parts I and II of this application to the following office by the date listed above:

                   College of Education Health, and Human Sciences Graduate Admissions
                            Department of Educational Psychology & Counseling
                                          453 Claxton Education
                                            Attn: Julie Harden
                                        Knoxville, TN 37996-3452
                                              (865) 974-1319

 The University of Tennessee Rehabilitation Counseling Program is accredited by the Council
                             on Rehabilitation Education, Inc.
Please indicate residency based on this information: The residence of a student, whether a minor or an adult, is
presumed to be the same as the student’s parents at the time of application to The University of Tennessee,
unless the student has independently established a residence of his/her own for at least one year prior to
applying for enrollment or re-enrollment before he/she can be classified as in-state for the purpose of paying
University fees and tuition.

 Residency (CIRCLE):                               IN-STATE         OUT-OF-STATE
 When do you plan to enroll?                       TERM: ________________ YEAR: ________________
 Will you enroll full-time or part-time? (CIRCLE):                FULL-TIME             PART-TIME
Please print clearly:

Date:          ______________
Name:          _________________________________________ _____________________
Social Security Number:              _______________________________________________
Date of Birth (optional):            _______________________________________________
Undergraduate GPA:                   ___________ Graduate GPA (if applicable):___________
Local/Current Address:               _______________________________________________
Permanent Address:                   _______________________________________________
Local Phone:                         _________ - __________ - __________
Work Phone:                          _________ - __________ - __________
Email Address:                       ____________________________@____________________________
I am interested in applying for (check one):
_______        1. Rehabilitation Counseling—Traditional Residential Program
_______        2. Rehabilitation Counseling—Deafness Focus (Read and Complete Appendix A)
_______        3. Rehabilitation Counseling—Distance Education (open to currently employed
                        rehabilitation counselors ONLY) (Read and Complete Appendix B)
_______        4. Rehabilitation Counseling—Deafness Focus Distance Education (open to currently
                        employed rehabilitation counselors ONLY) (Read and Complete Appendices A and
Please submit a detailed typed statement covering the following. Please be as specific and
succinct as possible in your answers.

   1. Name, address, telephone number(s), email address
   2. List previous courses in psychology, sociology, rehabilitation counseling, human
      services, and related areas.
   3. List and submit copies of theses, dissertations, special projects, and publications.
   4. List honors, awards, or other academic or professional recognition.
   5. List work or volunteer experience, if any, which is related to rehabilitation.
   6. List organizational memberships, present and past. Include dates of membership.
   7. Submit evidence of achievement in rehabilitation or related fields or other evidence of
      ability to work successfully with people.
   8. Briefly discuss each of the following:
         a.     What led you to decide you wanted to study/work in this area?
         b.     When did you decide?
         c.     Comment on contacts made with people presently employed as rehabilitation
                counselors. Please give names and, if known, addresses. (Lists of counselors to
                contact are available from present students and the Program Coordinator).
         d.     Based on these contacts, what are your feelings about being identified as a
                professional working in the field of rehabilitation?
         e.     In what ways have you made certain you understand what basic skills and
                duties are necessary for success as a rehabilitation counselor?
         f.     How do you plan to utilize this training in future rehabilitation work?
         g.     Why do you particularly want to work with people who have disabilities?

               University of Tennessee Non-discrimination Policy Statement

  All qualified applicants will receive equal consideration for employment and admissions
 without regard to race, color, national origin, religion, sex, pregnancy, marital status, sexual
  orientation, gender identity, age, physical or mental disability, or covered veteran status.

    Eligibility and other terms and conditions of employment benefits at The University of
   Tennessee are governed by laws and regulations of the State of Tennessee, and this non-
     discrimination statement is intended to be consistent with those laws and regulations.

In accordance with the requirements of Title VI of the Civil Rights Act of 1964, Title IX of the
     Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the
Americans with Disabilities Act of 1990, The University of Tennessee affirmatively states that
  it does not discriminate on the basis of race, sex, or disability in its education programs and
               activities, and this policy extends to employment by the University.

   Inquiries and charges of violation of Title VI (race, color, national origin), Title IX (sex),
   Section 504 (disability), ADA (disability), Age Discrimination in Employment Act (age),
  sexual orientation, or veteran status should be directed to the Office of Equity and Diversity
(OED), 1840 Melrose Avenue, Knoxville, TN 37996-3560, telephone (865) 974-2498 (V/TTY
 available) or 974-2440. Requests for accommodation of a disability should be directed to the
                    ADA Coordinator at the Office of Equity and Diversity.
                                         APPENDIX A


The Deafness Focus option in Rehabilitation Counseling is intended for those persons who wish
to serve individuals who are deaf and/or have hearing impairments. Preparing to serving
individuals from this population as a rehabilitation counselor requires that the student
demonstrate proficiencies and participate in activities in addition to and different from those of
students pursuing the traditional rehabilitation counseling degree. The following is a list of the
additional requirements for students who are entering the Deafness focus at the University of

1.    Completion of the Orientation to Deafness (OTD) program offered through the
      Center on Deafness at the University of Tennessee: The Orientation to Deafness
      program is offered in the summer term as a non-credit immersion experience for persons
      whose professional duties require interaction with the deaf community. It is expected
      that the OTD program be completed prior to admission to the Deafness Focus
      rehabilitation counseling option, but in certain circumstances, at the discretion of the
      Rehabilitation Counseling program coordinator, students may be admitted to the deafness
      focus prior to completing OTD with the understanding that OTD must be completed
      before the degree is granted. (Students who have participated in an equivalent program
      may substitute that experience with the approval of the UT Center on Deafness).

      Have you completed OTD?          No    Yes (Date and Location)


      (Please contact the UT Center on Deafness for information on the OTD program by
      calling 865-974-0607)

2.    Demonstration of American Sign Language (ASL) Proficiency at an Intermediate
      Level on the Sign Language Proficiency Interview (SLPI): Students will be tested by
      an appropriately trained assessor from the UT Center on Deafness or other designated
      assessor to assure that this level of ASL skill has been achieved. Students who do not
      demonstrate at least intermediate ASL proficiency may be admitted to the Deafness
      Focus option, at the discretion of the Rehabilitation Counseling program coordinator,
      with the understanding that intermediate ASL skills must be demonstrated on the SLPI
      before the degree is granted. Students should be aware that ASL courses are NOT part
      of the 48 hour rehabilitation counseling curriculum. Students who require classroom
      instruction in ASL must complete this training in addition to the rehabilitation counseling

Appendix A—Deafness Focus—Continued:

3.    All external course assignments (interviews, term papers, etc.) must be related to
      deafness or hearing impairment issues. All external classroom assignments in each RC
      course must relate to deafness or hearing impairment.

4.    The 100 hour Practicum and 600 hour Internship must be completed in a setting in
      which the student delivers rehabilitation counseling services to individuals who are
      deaf or have hearing impairments.

Statement of Student Understanding:

I have read and understand the requirements for admission, participation in, and completion of
the Deafness Focus option in Rehabilitation Counseling at the University of Tennessee-
Knoxville as stated in Appendix A of the program application. I understand and agree that prior
to the granting of my degree I will meet conditions 1-4 described in Appendix A.

Student Name (Print or Type)

Student Signature

                                         APPENDIX B


The UT Rehabilitation Counseling Program initiated course delivery via distance education as a
pilot project during fall semester, 2007. Courses are delivered via a system known as Centra,
which allows students to attend courses synchronously (i.e., at the same time as) students who
are participating in traditional classroom instruction. Students who attend through Centra have
access to real-time audio and graphic presentations (i.e., PowerPoint slides), and can interact
with the instructor via text chat or a microphone attached to their computer. For more
information on this system please visit

Most material delivered via Centra is archived for student review, allowing an ―asynchronous‖
(i.e., not at any particular time) class attendance when students cannot participate in classroom
activities due to other responsibilities (i.e., work schedules). Although for most courses in the
rehabilitation counseling program asynchronous attendance is permitted, students should be
aware that in certain circumstances instructors may make synchronous (i.e, “real time”)
attendance a requirement for certain class activities. Courses have been moved to start times
after 6:00 Eastern Time/5:00 Central Time to allow students the opportunity to attend classes
synchronously while minimizing conflict with traditional work schedules.

Students admitted to the Rehabilitation Counseling Program after December 31, 2008 will
be admitted through distance education only if they are currently employed as a
rehabilitation counselor on a full or part-time basis. Students who are admitted to the
traditional residential rehabilitation counseling program may take certain courses via
distance education with the permission of the instructor and program coordinator. It is
recognized that in some circumstances students may have no option but to take a course
via distance education (low enrollment, field experience away from Knoxville, etc.).

The distance education program typically requires two years of mixed full and part-time study
to complete. Cohorts will be considered for admission in even years (2008, 2010, 2012, etc.),
and a total of at least nine students must be admitted in a cohort to have the cohort accepted for
distance education. When cohorts fall below nine, students will have the option of 1) entering
traditional classroom education or 2) waiting until nine or more students can be admitted.

I have read and understand the conditions for acceptance into and completion of the
distance rehabilitation counseling master’s degree program.

______________________________________              ____________________
Name (print)                                        Date

Name (signature)
                                        University of Tennessee
                                    Rehabilitation Counseling Program

         Statement on Taping Requirements for RC 547 Practicum in Rehabilitation Counseling

RC 547 (Practicum in Rehabilitation Counseling) is a required course in the rehabilitation counseling
curriculum. Students must complete the all the requirements of the practicum in order to earn the Master’s
degree; practicum is also a prerequisite course for the 600 hour Internship.

A requirement of Practicum is audio or videotaping of rehabilitation counseling sessions. The number of tapes
a student must complete may vary, but is usually no less than three and no more than five.

CORE accreditation requirements demand that audio or video tapes be included as a part of the
practicum. For this reason, a student’s practicum site MUST permit taping of clients/consumers after
obtaining proper informed written consent of counselees. It is the student’s responsibility to ascertain if
a practicum placement forbids taping. Such sites are not suitable for the practicum.

I have read and understand the above statement regarding practicum placement.

_________________________________________                  _________________________
Applicant Name (Print)                                     Date

Applicant Signature