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Education Form
The following information identifies you (the applicant) to the School/Educational Institution where education in psychology
was received. This form will automatically populate with your identifying and contact information. Ensure this information is
correct then sign, date and send this form to the School/Educational Institution who will then complete the form and mail it
directly to ICD. Please note: Depending on the jurisdiction, additional information may be required by the regulatory body
that you apply to after completion of the CES: ACPRO program if the individual bylaws / policies require.

Part A: Personal Information

ID Number: CT-00294815 Order Number: APP-00175935
First/Given Name: Sadia Date of Birth: 04-15-1988
Middle Name: Phone Number: +923485671788
Last/Family Name: Mustafa Email Address: saadiamustafa243@gmail.com

Name used when attended this school: Sadia Mustafa

Mailing Address:
Address 1: 128 A Khyber Block Allama Iqbal Town Lahore
Address 2:
Address 3:
City/Town: Lahore
Province/State/Territory: Punjab
Postal Code/Zip Code: 54000
Country: Pakistan

Name of school of educational institution: Government College University Faisalabad

• Did this school close or merge with another school? No
• If yes, name of institution where transcripts and training records are archived:
Attendance Start Date: 9/1/2008 12:00:00 AM
Attendance End Date: 3/31/2010 12:00:00 AM

I, Sadia Mustafa, hereby give my consent to Government College University Faisalabad to provide the information and
documents related to my education requested in this form, and to send this completed form and documents directly to
ICD at the following address:

For Standard and Courier:

International Consultants of Delaware
3600 Market Street, Suite 450
Philadelphia, PA 19104-2651 USA

Applicant Signature:______________________________________________ Date Signed__________________________________________

If you have any questions, please contact ICD via phone at +1 (215) 243-5858 or use the Support option in your ICD
Applicant Portal.

THIS FORM IS VALID FOR THE BELOW PERSON AND SCHOOL

Sadia Mustafa, Government College University Faisalabad
APP-00175935
EDU-00233705, Page 1
 Part B: Education Information
To be completed by the official authority: Please provide the following information (in English) concerning the
education of this applicant. Please spell out all names fully (no initials or abbreviations).
Do not leave any fields blank; mark questions that are not applicable as N/A.

Government College University, Faisalabad

Name of your school at the time of the applicant’s attendance: ____________________________________________________________

Government College University, Faisalabad

Current name of your School:________________________________________________________________________________________________

What type of school/educational institution is your institution?

Secondary Vocational College

Hospital University

English
What is the primary language used at your educational institution?_____________________________________________

Sadia Mustafa
Name of the student as it appears on the official transcript:_____________________________________________________________

Name of the credential/degree obtained: Master of sciences (Applied Psychology)

______________________________________________________________________________

Applied Psychology
Focus of the degree/Area of Study (e.g.: clinical psychology, forensic psychology):_________________________________________

What are the minimum entrance requirements for admission to this program?
___________________________________________________________________________________________________________________________
Bachelor of Arts (Psychology)
___________________________________________________________________________________________________________________________

What is the prescribed length of the study?____________________________________________________

2 years
English
Language of theoretical instruction:________________________________________

English
Language of clinical instruction:______________________________________________

9-01-2008
Date this applicant started this program:________________________________________

Did the applicant complete the program? Yes No

3-3-2010
If Yes, date this applicant gradated or formally competed the program:_____________________________________________

N/A
If No, last date of attendance:___________________________________________________

How was this program delivered?

On site in class learning On-Line distance learning Blended (Combination of in-

person and on-line instruction)

Internship at Allied Hospital ll, Civil hospital

Other (Explain): ______________________________________________________________________________________________
Faisalabad
Date your institution began offering this program:_____________________________________________(dd/mm/yyyy)

Date the program was initially accredited/approved:___________________________________________(dd/mm/yyyy)

THIS FORM IS VALID FOR THE BELOW PERSON AND SCHOOL

Sadia Mustafa, Government College University Faisalabad
APP-00175935
EDU-00233705, Page 2
What organization initially accredited/approved this program?_________________________________________________________

Date of most recent accreditation/approval renewal_____________________________________________(dd/mm/yyyy)

What organization granted the most recent accreditation/approval for this program?______________________________________

Date of current accreditation/approval expiration:_______________________________________________(dd/mm/yyyy)

Level of accreditation (if applicable):_____________________________________________________________

Please provide the following additional information and documents with this completed form:

• Official transcript of this applicant's education: This is the official document or record of this
applicant's enrollment, progress and achievement within your education institution. The transcript should
identify courses taken (title and course number), credits and grades achieved, theoretical and clinical
hours and credentials earned. Included with the transcript should be any supporting documents
appropriate for education programs in your jurisdiction, such as Related Learning Experience
(Philippines), school and university mark sheets (India) and diploma supplements (European Union
Countries);

• Education program curriculum: a written description of this applicant's program of study and its individual courses.
This can be included digitally (USB drive, CD, etc.). Please note that if you have already sent this material to ICD
for a different applicant, you do not need to submit an addition curriculum;

• Education syllabus for each course: a detailed outline and summary of the topics covered in each course, including
course objectives, learning outcomes and hours of study. Include any document that would provide supplemental
detail to what was taught in your Program. Please note that if you have already sent this material to ICD for a
different applicant, you do not need to submit an addition syllabus.

• Evidence of Accreditation/Approval of the education program at the time of the applicant’s education.

ICD will verify the authenticity of all documents received. If this is the first time your institution is sending
information to ICD or if you have changed the appearance (stamp, seal, watermark, hologram, etc.) of your
academic records within the past year, please provide a separate document with samples or a description of the
authentic documents along with the names and signatures of the people authorized to submit these materials. In
addition, please provide the name and direct contact information of the official authority for the purpose of
verification.

PLEASE SEE NEXT PAGE

THIS FORM IS VALID FOR THE BELOW PERSON AND SCHOOL

Sadia Mustafa, Government College University Faisalabad
APP-00175935
EDU-00233705, Page 3
 Part C: Education Domain Breakdown
In addition to attaching a copy of the official transcript of this applicant's education, with a program curriculum and
syllabus for each course, please indicate whether your education program included the below content area by indicated
“Y” for yes or “N” for no in the In Evidence Column. In addition, if a content area is in evidence please indicate the
course(s) that the content area was taught.

Domains Content Area In Evidence Course(s)

Foundational Knowledge
Interpersonal Relationship
Assessment and Evaluation
Intervention and Consultation
Research
Ethics and Standards
Supervision
(Y/N)
Knowledge of Biological Basis of Behavior
Y Behavior Neurosciences
Knowledge of the Cognitive-affective Bases of Behaviour Y Cognitive and affective processes
Knowledge of the Social Bases of Behaviour Y Social psychology
Knowledge of Psychology of the Individual Y Personality psychology
Psychopharmacology N
Knowledge of theories and empirical data on the
professional relationship Y Personality psychology
Knowledge of self Y Cognitive and affective processes
Knowledge of others Y Social psychology
Interpersonal Skills Y Organizational Psychology,Human resources
Management
Assessment (psychometrics) Y Psychometrics
Evaluation Y Clinical psychology, Psychological testing
Intervention Y Health psychology
Consultation Y Counseling psychology
Research Theory (Statistics, Research Methods, Research methodology, Application of statistics in psychology,
Y psychometrics
Psychometrics)
Consumption of Research Y Research methodology
Conducting Research Y Research methodology
Ethical Principles Y Research methodology l
Ethical Standards Y Research methodology ll
Supervision/Management Y Internship
Teaching Y Educational psychology

Current address of this school of educational institution:

Name:_______________________________________________________________________________________________________________________
Government College University,Faisalabad
Address 1:___________________________________________________________________________________________________________________
Faisalabad ,Alama Iqbal road
Address 2: __________________________________________________________________________________________________________________
P.O. Box:_____________________________________________________________________________________________________________________
City/Town:___________________________________________________________________________________________________________________
Faisalabad
Province/State/Territory:____________________________________________________________________________________________________
Punjab
Postal Code/Zip Code:______________________________________________________________________________________________________
38000
Country:_____________________________________________________________________________________________________________________
Pakistan

Current address of any affiliated University:

Name:_______________________________________________________________________________________________________________________
Address 1:___________________________________________________________________________________________________________________
Address 2: __________________________________________________________________________________________________________________
P.O. Box:_____________________________________________________________________________________________________________________
City/Town:___________________________________________________________________________________________________________________
Province/State/Territory:____________________________________________________________________________________________________
Postal Code/Zip Code:_______________________________________________________________________________________________________
Country: _____________________________________________________________________________________________________________________

THIS FORM IS VALID FOR THE BELOW PERSON AND SCHOOL

Sadia Mustafa, Government College University Faisalabad
APP-00175935
EDU-00233705, Page 4
 Part D: Identification of Official
To be completed by the official authority. Please provide the following information, and spell out all names fully
(no initials or abbreviations). Mail this completed form and all documents directly to ICD.

Official authorized to provide transcripts

Printed name: _________________________________________

Dr khalid Mehmood Official Title: ____________________________________________
Associate professor of psychology
Phone Number: _______________________________________
00923336600882 Alternate Phone Number: ____________________________________
(123-456-7890 format with country code)

khalidmehmood@gcuf.edu.pk
Email Address: ________________________________________ Website Address: ______________________________________________

By signing below, I certify all information is true and correct to the best of my knowledge and has been provided by has
been provided by the appropriate primary source.

Official’s Signature: ______________________________________ Date Signed: _____________________________________(dd/mm/yyyy)

[Official signature, date signed, and seal or stamp are required for this document to
be accepted.]

In the space to the left, place the official seal or stamp of this organization.

If the official providing the educational instruction information is a different official, please provide the name and
signature of this official as well.

Official authorized to provide educational information

Printed name: _________________________________________ Official Title: ____________________________________________

Phone Number: _______________________________________ Alternate Phone Number: ____________________________________
(123-456-7890 format with country code)

Email Address: ________________________________________ Website Address: ______________________________________________

By signing below, I certify all information is true and correct to the best of my knowledge and has been provided by has
been provided by the appropriate primary source.

Official’s Signature: ______________________________________ Date Signed: _____________________________________(dd/mm/yyyy)

[Official signature, date signed, seal or stamp are required for this document to be accepted.]

Postal and Courier Mailing Address

International Consultants of Delaware
3600 Market Street, Suite 450
Philadelphia, PA 19104-2651 USA

If you have any questions, please contact ICD via phone at +1 (215) 243-5858.

THIS FORM IS VALID FOR THE BELOW PERSON AND SCHOOL

Sadia Mustafa, Government College University Faisalabad
APP-00175935
EDU-00233705, Page 5