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.