UNIVERSITY OF PRACTICAL PSYCHOLOGY AND SOCIALOGY URARTU 19a. Koryun Street, Yerevan, Armenia 375009 Tel. (37 41 0) 52 82 42 | Fax: (37 41 0) 56 64 63 | Email: urartu1@mail.ru or info@urartuuniversity.com 1. PERSONAL DATA Name: Nationality: Address: City: Country: Date of Birth: Day: Month: January February March April May June July August September October November December Year: Age: Place of Birth: Sex: Male Female Marital Status: Married Not Married Number of Children / Dependants: Telephone No: Fax: E-mail In case we have to contact you by telephone, what will be the best time, and at what number? Best Time: Work No: Home No: 2. DEGREE PROGRAM What is the specific degree program you wish to enroll in? Bachelor Degree Masters Degree Ph. D. (Doctorate) Degree Please indicate your proposed area of study. Clinical psychology and psychotherapy Management and management psychology Pre-school and school psychology Forensic psychological expertise Social work Juridical psychology Pedagogies and psychology 3. PREVIOUS EDUCATION Please attach original copies of transcripts, or have them forwarded to the Urartu University as soon as possible. Photocopies are accepted for initial evaluation. College / University City Country From To Major Degree Awarded No. of Units High School City Country Graduation Date Diploma 4. EMPLOYMENT HISTORY Please list all employment experience, starting with current or more recent. Business / Employer's name Telephone Number From To Position 5. LANGUAGES Besides your mother language, which is , please list your efficiency in any other language(s). Language: Reading: Excellent Good Fair Writing: Excellent Good Fair Speaking: Excellent Good Fair Language: Reading: Excellent Good Fair Writing: Excellent Good Fair Speaking: Excellent Good Fair Language: Reading: Excellent Good Fair Writing: Excellent Good Fair Speaking: Excellent Good Fair Language: Reading: Excellent Good Fair Writing: Excellent Good Fair Speaking: Excellent Good Fair Language: Reading: Excellent Good Fair Writing: Excellent Good Fair Speaking: Excellent Good Fair

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