Other Information

OTHER BACKGROUND INFORMATION

Language Proficiency

Please select your native language (the language of your birth) from the drop-down menu. If you have any experience with additional languages, please indicate which ones and the level of your proficiency in each under “additional language.” You can click the “Add Another Language” button to add more entries.

U.S. Military Experience

Select your current military status from the drop down menu if you have had U.S. military experience. Select “Not a member of the military” if this does not apply.

Misdemeanor and Felony Convictions

Select “Yes” in the appropriate box if you have been convicted of a misdemeanor or a felony, and provide a brief explanation in the space provided. Select “No” if you have no convictions.

IMPORTANT: Some programs require background checks as a condition of acceptance pending satisfactory results. Failure to disclose prior convictions may have serious consequences, such as annulment of acceptance offers, program dismissal, or Professional Code of Conduct violation sanctions.

Background checks reflect all prior convictions, guilty pleas, city ordinance citations (such as public intoxication), illegal possession(s) including possession of alcohol under the legal age, payments of fines (including those for traffic violations), and in some cases, prior records thought to have been expunged. Please note that in some states, common traffic violations may be considered misdemeanors. Candidates with criminal records due to felony offenses are encouraged to be aware of the potential impact for CSD program acceptance and future licensure. Contact the programs you wish to apply to and state licensing agencies where you hope to practice for advice if you have a felony conviction or a criminal record.

If you are uncertain of the status of a charge vs. a conviction on your record, or if you are uncertain as to whether your offense was an infraction, misdemeanor, or a felony, contact the city, county, or state jurisdiction where the incident occurred.

If you are convicted of a misdemeanor or felony prior to matriculation, it is your responsibility to IMMEDIATELY inform you designated program(s).

License Infraction

Please check “Yes” if you have had any certification, registration, license or clinical privileges revoked, suspended or in any way restricted by an institution, state or locality. Please provide a brief explanation. Select “No” if this does not apply.

Academic Infraction

Check the box if you have been disciplined or placed on academic probation while attending an academic institution. Explain in the space provided.



Top