Name: ________________________________ Telephone: ___________________________
Best time(s) of day to be contacted: _________________________________________________
Are you interested in participating for more than one semester? Y N Cumulative GPA: ______
Psychology courses completed or
currently enrolled:
Institution
Grade received
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Please clarify your interest in this particular project: ____________________________________
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What are your plans following graduation? If graduate school,
what area of study?
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Do you have any special skills or relevant experience? __________________________________
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Have you been involved in Psyc 4990 before? Y N If
yes, with whom, and what were your duties?
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-----------------------------------------------------------------------------------------------------------------please
detach form along dotted line---------------------
Student: if you are accepted into 3990 or 4990, please ask your faculty member to complete and detach this form. Then you need to return the form to Silvia Daggy in room 102 North Murray Hall.
Date: ___________________
I agree to let ________________________ enroll in (circle one) Psyc 3990/Psyc 4990, section number ____, for ___ hours of credit for the _________ semester.
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Faculty signature