Name: 

Phone number(s): 

Email address:

Year in school:  freshman sophomore junior senior other

Major: 

Cumulative GPA: 

SAT score: 

ACT score: 

Plans upon graduation: 

Previous psychology courses taken:

Previous math and statistics courses taken:

Any previous research experience? Yes No

If yes, please describe:

Whom may we contact to obtain a reference for you (professor or employer)?

Name:        

Relation to you:

Phone:

Email:

How dependable are you?

	Very undependable
	Undependable
	Somewhat undependable
	Average
	Somewhat dependable
	Dependable
	Very dependable

Choose one:

     I would be interested in working on behind-the-scenes research.

     I would rather do more work as an experimenter.

     I would be interested in both types of work.

Some research work may involve the use of various software.  Use the following scale to indicate your level of experience with the following software:

1 = no experience
2 = light experience
3 = moderate experience
4 = heavy experience
5 = expert

Microsoft Word: no experience light experience moderate experience heavy experience expert

Microsoft Excel: no experience light experience moderate experience heavy experience expert

Microsoft Powerpoint: no experience light experience moderate experience heavy experience expert

SPSS: no experience light experience moderate experience heavy experience expert

Adobe Photoshop or Illustrator: no experience light experience moderate experience heavy experience expert

HTML/designing web pages: no experience light experience moderate experience heavy experience expert

Visual Basic:   no experience light experience moderate experience heavy experience expert

Any other comments you feel we should take into consideration:

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