Department of Counseling, Clinical, & School Psychology Ph.D. Application Questionnaire (2027-2028 Academic Year) Section 1: Applicant Information Legal Family Name * First Name * Middle Name Email Address * Phone Number (Format: 805.893.XXXX) * UCSB Perm Number (if applicable) Applying Quarter & Year * Section 2: Primary Area of Study Although the department offers a Clinical/Counseling Program and a School Psychology Program, all applicants must apply to one primary area. What primary area are you applying to? (Choose one) Counseling Psychology Ph.D. Clinical Psychology Ph.D. School Psychology Ph.D. School Psychology M.Ed. For School Psychology Ph.D. Applicants If you are applying for the School Psychology Ph.D. program and we are unable to admit you, would you like to be considered for the School Psychology M.Ed. program? YES NO Section 3: Faculty Mentor Selection Because we adhere to a mentor model of advising, it is important that you only select faculty members within your chosen emphasis area with whom your interests are compatible. Select your proposed mentor(s) below. Counseling Dr. Nolan Krueger Dr. Shola Shodiya Clinical Dr. Miya Barnett Dr. Ty Vernon Dr. Erika Felix Dr. Castellon School PhD Dr. Erin Dowdy Dr. Shane Jimerson Dr. Matthew Quirk Dr. Jill Sharkey School MEd Dr. Jon Goodwin Dr. Arlene Ortiz Section 4: Applicant Statement & Research Interests Proposed Area of Research Interest: * Briefly summarize the specific research area(s) you intend to pursue and how your interests align with the mentor(s) selected above. (Max 1500 characters) Statement of Purpose Summary (Fit with CCSP Advisor/Program): * Explain why you are choosing the UC Santa Barbara CCSP department and why your background makes you a strong fit for your selected emphasis and advisor model. (Max 1500 characters) Section 5: Applicant Confirmation & Electronic Signature I certify that all information in this questionnaire is accurate and that I have reviewed the faculty mentor matches on Page 1. * I agree to the electronic submission of this form and understand that it is a required part of the Ph.D. application process. * Applicant Electronic Signature * Date * Generate Printout Clicking this will validate your required fields and open a clean, printable copy of your application questionnaire.