Postgraduate Program in Bowen Family Systems Theory and Its Applications
Application Form
Please mail the completed appplication to Victoria Harrison, MA, PO Box 701187, Houston, TX 77270-1187.If you require more space, please
add additional sheets.
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Full Name:
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Home Address:
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Place of Employment:
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Professional Background: List positions held since completing
college, most recent first.
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Educational Background: List college, university, or any
other educational institution attended.
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Location |
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Degree |
Date Conferred |
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Are you currently a candidate for a degree? If so, give university,
area of specialization, degree to be earned, and expected date of
graduation.
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Scholarships, fellowships, academic awards, or honors received:
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In addition to training from degree-conferring institutions, what
professional training have you had?
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Location |
Course |
From Mo/Yr |
To Mo/Yr |
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List research experience and interests. Please include published
and unpublished papers.
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List membership in professional organizations and associations.
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How did you become acquainted with and interested in this program
at the Center?
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Has any relative or significant other made application or been accepted
to this program?
Personal Data
Date of Birth________________________________Place of Birth____________________________________
Marital Status_______________________________ Name and Age of Spouse___________________________
Date(s) of Marriage(s)________________________ Date(s) of Divorce(s)_______________________________
Children: (List from oldest to youngest)
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Age |
Education |
With whom does this child live? |
General functioning of child |
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Person to notify in case of emergency:
Name:_____________________________________ Relationship:_________________________________________
Address:___________________________________ Telephone:___________________________________________
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HEALTH
How would you describe the current state of you health? (Circle one)
Excellent Good Fair Poor
List any serious illness, physical or emotional, (current or chronic)
in yourself, your immediate household,
or extended family.
Are you currently in psychotherapy? What is the theoretical orientaion
of your therapist?
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ESSAY QUESTIONS
On separate sheets of paper, please address the following questions:
1. What are your major long-term professional interests and goals?
How do you see this program as relevant to these goals?
2. What is your current theoretical base for conceptualizing human
behavior and guiding your professional work? How did you arrive
at your current theoretical orientation? What have you found to
be the strengths and weaknesses of this theoretical base?
3. Draw a family diagram showing generations of your extended family
back at least to your great-grandparents. Give a brief history of
your family focusing on geographical location, peoples’ functioning
on a socioeconomic and an emotional level, any significant events,
and the level of contact you have had with each of your parent's
extended families. Describe how you function emotionally in your
family. How have you tried to deal with the challenges your family
presents?
4. Please describe your previous experience with Bowen theory and
the study of family systems.
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Signature_____________________________________________
Date_________________________________________________
Application fee enclosed_________________________________
7/8/03
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