University of Toledo

University of Toledo Graduate Student Annual Review of Professional Activities (GARPA) Reporting Period: May 16, 20__ to May 15, 20__ Name: Year in Graduate Program: Year of Entry: Gender: Male Female Ethnicity (these are APA's categories): African American – Black Asian – Pacific Islander Caucasian – White Latino – Hispanic Native American – Alaskan Native Multi-Ethnic Other I am subject to the Americans with Disabilities Act: Yes No I am a Foreign National: Yes No Nature of financial support during AY 20__-20__ (e.g., TA and related class(es), grant support – if more than one type, state the number of hours for each):

Contact Information (include address and email):

Please complete the following items for the reporting period May 16, 20__ to May 15, 20__: 1. Please list all professional or research societies to which you belong:

2. Please give citations (APA style) for all papers, posters, workshops, or other professional presentations at professional or research meetings on which you were author or co- author:

3. Please give citations (APA style) for all accepted or published articles, chapters, or books on which you were author or co-author (specify: accepted or published):

4. Please list any grant-supported research in which you were involved (indicate whether you received the grant or were supported by a grant from a faculty member): 5. Please list all ongoing teaching activities (specify whether course taught, lectures or other formal or informal talks, teaching assistant work):

6. Please list all supervised practicum training (on or off campus) (includes practicum and externships activities but not internship activities):

7. For students who are not currently on internship or postdoc, please report all of your practicum training activities in the Practicum Hours Tables (see accompanying file). If you are going on internship this year (2011), also attach your AAPI Part 1.

8. Did you apply for internship for the 2011-2012 year? Yes No If you answered Yes, did you get an internship placement for the 2011-2012 year? Yes No

9. For students accepted into an internship program (that starts in 2011), please (a) attach your AAPI Part 1 to your GARPA and (b) answer the following: Name of internship site:

Date internship starts:

Completion date for your internship:

Internship setting: N/A Is it a paid internship? Yes No Is it a member of APPIC? Yes No Is it APA accredited? Yes No Is it a full-time or part-time placement? Full-time Part-time Is it a funded or unfunded placement? Funded Unfunded

10. For students currently on internship (who started in 2010), please provide the following information about your upcoming postdoctoral activities:

Name or names of sites (if more than one site, please list the percent amount of time spent at each): Postdoctoral or Employment? N/A Setting N/A Activity N/A Choose the main activity you are engaged in. 11. Please list all clinical program requirements completed during the reporting period.

Requirement Date Committee Members' Names Passed Master's Thesis Proposal Passed Master's Thesis Defense Received Master's Degree Major Advisor: Passed Professional Development Case Presentation Passed Professional Development Project Passed Dissertation Proposal Passed Dissertation Defense Received Doctorate Major Advisor: Started Internship Completed Internship Started Postdoc or Post-Internship Employment Finished Postdoc or Post-Internship Employment

12. Students who are not currently on internship or postdoc: Please list all talks and training workshops attended either within or outside of the department, including job talks.

13. Students who are not currently on internship or postdoc. Please list all department and university service you carried out (committees served on, graduate student mentoring, interviewing of prospective faculty or grad students, etc.):

14. All students: Please list and describe any other relevant achievements accomplished.