1. Behavioral Research Supervisory System Application
Name (please print):__________________________________________________
WIN:_______________________
Semester(s) of Interest (indicate what year, e.g. spring 2013, fall 2014):
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:_____________________________________________

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?

3. Behavioral Research Supervisory System Application
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 with
him/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, quality
of work, and “personality.” Please explain why you ranked this student the way you did in the previous
question.