1. Behavioral Research Supervisory System ApplicationName (please print):__________________________________________________WIN:_______________________Semester(s) of Interest (indicate what year, e.g. fall 2012, spring 2013):Fall ______ Spring ______ Summer (thesis only, limited space)_______ Email:__________________________ Current Class: 1400 3600 4600 Local Phone:_____________________ TA Name:________________________ Local Address:___________________ Previous Malott Courses: _______________________________ Psy 1400- TA Name:________________ _______________________________ Grade:_________ Permanent Phone:________________ Psy 3600- TA Name:________________ Permanent Address:______________ Grade:_________ _______________________________ Psy4600- TA Name:________________ _______________________________ Grade:_________ _ Overall GPA:_________ Psychology GPA:_________ Expected Graduation Date:_____________ Are you interested in completing a thesis (2 semesters, 6 credits) or not completing a thesis (1 semester, 3 credits)? A thesis allows you to graduate with departmental honors. (Circle preference) Thesis Non-Thesis Practicum Experience (please circle): Location: KAC WE Level: Basic IP AP Supervisor Name:______________________________________________________ Other Practicum Experience:_____________________________________________Please answer the following questions: 1) What qualifications do you think you have that would make you an ideal candidate for BRSS?
2. Behavioral Research Supervisory System Application 2) How would being a part of BRSS be beneficial to you? 3) What are your future plans/goals and how does BRSS fit into these plans?FOR TA USE ONLY:Student’s Grade: Overall Rank in Class: out of:Recommend this student very strongly or highly if you are fairly certain that you would love to work withhim/her on your own project!Please circle appropriate answer:I [very strongly] [highly] [moderately] [do not] recommend this student for PSY 398/499 work.Your personal comments: Please be very descriptive regarding the student’s professional mannerisms, qualityof work, and “personality.” Please explain why you ranked this student the way you did in the previousquestion.