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  • 1. Behavioral Research Supervisory System Application Name(please print):__________________________________________________ WIN:_______________________ Semester(s) of Interest (indicate what year, e.g. spring 2014, fall 2014): Fall ______ Spring ______Summer (thesis only, limited space)_______ Email:__________________________ Local Phone:_____________________ Local Address:___________________ _______________________________ _______________________________ Permanent Phone:________________ Permanent Address:______________ _______________________________ _______________________________ Current Class: 1400 3600 4600 3970 GSI/Supervisor Name:________________________ Previous Malott Courses: Psy 1400- TA Name:________________ Grade:_________ Psy 3600- TA Name:________________ 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:_____________________________________________ Project Preference: Organizational Autism Behavioral Management
  • 2. Behavioral Research Supervisory System Application Please answer the following questions: 1) What qualifications do you think you have that would make you an ideal candidate for BRSS? 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 GSI 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 with him/her on your own project! Please circle appropriate answer: I recommend this student [very strongly] [highly] [moderately] [with reservations] [I do not recommend] for PSY 398/499 work. Your personal comments: Please be very descriptive regarding the student’s professional mannerisms, quality of work, and “personality.” Please explain why you ranked this student the way you did in the previous question.

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