Today's Date: Expected Graduation Date:

Year: CHOOSE ONE Senior Junior Sophomore Freshman Other Major (if known):

Phone: ( ) E-mail:

Do you have access to a car? yes

Number of hours per week you wish to work: CHOOSE ONE 4 (1 credit) 7 (2 credits) 10 (3 credits)

What times of the day are you free most? Mornings Afternoons Evenings

Have you taken any of the following courses? If so, please fill in your instructor's name and your grade in the course. Also, add any courses that you think might be relevant to developmental or cognitive psychology (e.g., HDFS, ED).

Other relevant courses:

Have you had any experience with children (e.g., babysitter, counselor, research)?

Have you had any research experience in another lab? If so, what did you do?

What are your career/educational goals (if known)? What are you hoping to gain from doing independent study?

How would you describe yourself (e.g., your academic and recreational interests, your personality)?

Do you have any special skills (e.g., drawing/art, graphic programs, web-technologies, etc)?