2024–25 PSYCAS Program Participant Agreement

School information

School name:

Department name:

Address line 1:

Address line 2:

City:

State:

Zip:

Program information

Program information (check all programs that are participating):

MA/MSPhDPsyDOther

Number of MA/MS programs joining PSYCAS?

What are the MA/MS program names?

Number of PhD programs joining PSYCAS?

What are the PhD program names?

Number of PsyD programs joining PSYCAS?

What are the PsyD program names?

Number of other programs joining PSYCAS?

What are the other program names?

Start term for all programs (check all that apply):

FallWinterSpringSummer

What is the start year for your term?

Estimated number of applications for all programs combined:

What software platform does your institution use to collect student information (e.g., Banner, PeopleSoft, etc.):

Billing and contact information

Please provide the name of two individuals that will be the primary contacts for all updates and communication from APA regarding PSYCAS.

Primary contact

First name:

M.I.

Last name:

Title:

Role (e.g., admission staff, program chair, etc.):

Email:

Alternate email:

Phone:

Alternate phone:

Secondary contact

First name:

M.I.

Last name:

Title:

Role (e.g., admission staff, program chair, etc.):

Email:

Alternate email:

Phone:

Alternate phone:

Billing contact

Contact name for PSYCAS invoice:

Billing contact email address:

Agreement Acknowledgment

I agree to the terms outlined in the 2024–25 PSYCAS Participation Agreement for and on behalf of my eligible program(s) and on behalf of the entity or institution in which my eligible program(s) are housed as outlined in the above information.

Upon clicking “I agree” and electronically signing below, this Agreement shall be legally binding on my eligible program(s) and the entity or institution in which they are housed.

I agree to the above terms.

Name (type)

Date