HomeMA in Clinical Mental Health Counseling Supplemental Questionnaire MA in Clinical Mental Health Counseling Supplemental Questionnaire Name(Required) First Middle Last Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address(Required) Instructions: We would like know more about your interest in becoming a counselor. Please address each of the following questions to the best of your ability. Please give careful thought to your answers. Consider these formal essays, paying attention to clarity of thought, grammar, and punctuation.Considering your personal, spiritual, and professional background, please explain why you chose Montreat as the place to pursue your degree? (At least 5 to 7 sentences)(Required)In 5-7 sentences, identify how you will use this degree in a counseling career.(Required)In at least 5-7 sentences, please answer the following question: What post-school or work-related experiences demonstrate your interest and dedication to the counseling profession or to the counseling specialty which you are applying?(Required)Please describe your understanding of cultural competence and how it applies to you as a counselor-in-training (At least 5 to 7 sentences)(Required)What are the reactions of your family, friends, and colleagues as you express your career goals to become a counselor? (5-7 sentences)(Required)Additional InformationDo you currently have a hold or balance at another institution that will prevent you from obtaining your official transcripts?(Required) Yes No Have you ever been convicted of a crime other than a minor/traffic or juvenile offense?(Required) Yes No Are there any criminal charges pending or expected to be brought against you?(Required) Yes No Have you ever been on academic/disciplinary or conduct related probation or been dismissed from any educational institution?(Required) Yes No Affirmation of Camera and Internet Access By checking here, I certify that I have access to camera-enabled, high-speed wifi. Affirmation of Evaluation By checking here, I indicate that I have read and understand the following: As you are seeking an education that will prepare you to become a future counselor, we are obligated to evaluate your potential for success for obtaining a professional license. Your candid responses to the following questions will allow us to better advise you regarding your ability to obtain licensure. If you have a criminal history, you should be aware that it may adversely affect your ability to obtain a professional license. It may also restrict you from certain practicum and internship placements to whom such a history must be disclosed. Affirmation of Accuracy By checking this box and submitting this questionnaire, I certify that I have reported my grades to the best of my knowledge and understand that Montreat College may use this information to determine my eligibility for admission prior to the receipt of my official transcripts at their sole discretion. I acknowledge that it is the policy of Montreat College that all applicants must submit official transcripts from all colleges and high schools attended, and any decision of admission afforded to me does not change the transcript requirement. I understand that my official transcripts will be used to confirm all self-reported grades and other course information provided here, and any false statements made by me in the self-reporting of my grades may invalidate further consideration for admission or result in rescinding of the offer of admission, if applicable. I further certify that all of the responses in this questionnaire are my own work, without the assistance of others. Student Electronic SignatureBy checking here I indicate that I have read and understand the following: As you are seeking an education that will prepare you to become a future counselor, we are obligated to evaluate your potential for success for obtaining a professional license. Your candid responses to the following questions will allow us to better advise you regarding your ability to obtain licensure. If you have a criminal history, you should be aware that it may adversely affect your ability to obtain a professional license. It may also restrict you from certain practicum and internship placements to whom such a history must be disclosed. By checking this box and submitting this questionnaire, I certify that I have reported my grades to the best of my knowledge and understand that Montreat College may use this information to determine my eligibility for admission prior to the receipt of my official transcripts at their sole discretion. I acknowledge that it is the policy of Montreat College that all applicants must submit official transcripts from all colleges and high schools attended, and any decision of admission afforded to me does not change the transcript requirement. I understand that my official transcripts will be used to confirm all self-reported grades and other course information provided here, and any false statements made by me in the self-reporting of my grades may invalidate further consideration for admission or result in rescinding of the offer of admission, if applicable. I further certify that all of the responses in this questionnaire are my own work, without the assistance of others.I agree and acknowledge that this document can be executed electronically and it is binding in every way as if signed by my hand.Student Electronic Signature: Name(Required)Student Electronic Signature: DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
