Summer Or Fall 2017 - DUE FEBRUARY 27, 2017

Summer or Fall 2017 - DUE FEBRUARY 27, 2017

INSTRUCTIONS:

Complete the attached APPLICATION AND SCREENING FORM to apply for the Psychology 491 program. Please return this completed form to Ms. Stephanie McWilliams’s mailbox in the Department of Psychology Main Office (Room 1124) by the due date listed above.

Application to the program also requires submission of two RECOMMENDATION FORMS by faculty or graduate students in the Psychology Department. Contact Ms. McWilliams to request permission if you want to ask someone else to complete one of these forms for you. You should give these forms to faculty or graduate students who know you well enough to rate your suitability for the Psychology 491 program. They will return the forms directly to Ms. McWilliams.

Unless you are contacted concerning a problem with your application, you will be sent, by e-mail, instructions on finding and arranging a spring placement by March 20,2017.

Questions about the program and the application process should be directed to

Ms. Stephanie McWilliams (e-mail: , phone: 304-293-0834, office: Room 1231).

DUE FEBRUARY 27, 2017

Datesubmitted

NameStudent no. e-mailaddress @mix.wvu.edu Phone Major Yearinschool Anticipated dateofgraduation OverallGPA

Number ofcreditsdesiredSemesterofplacement:FallSpring

Summer

List in rank order up to six placement sites where you would like to interview. See the program description for information on available sites. You also may list sites or locations that are not included in the program description if you are interested in arranging your own placement. Be sure to submit a Request for Placement Approval before finalizing a placementifitisnotlistedonthelistofavailablesites.

1.

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If you have previously participated in or been approved for PSYC 491, complete the following information:

participatedapprovedSemester andyear:

If you previously participated in or were approved for the course, you need only turn in this page. You do not need to complete remainder of the form or obtain additional recommendations.

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Whatareyourareasofinterestinpsychology?

WhatareyourplansafterfinishingyourBachelor’sdegree?

Listanypaidjobsyouhaveheld

Listanyvolunteerworkyouhavedone

List by number the Psychology courses you have completed and those you are currently taking (for spring placements, also list courses planned for summer and fall):

Completed: Taking: Planned:

Listanyactivitiesyouhaveengagedinwithindividualfacultymembersorgraduatestudents inthePsychologyDepartment(includingPSYC490,495,and498):

Beloworonanattachedsheet,brieflydescribewhyyouwouldliketoparticipatein Psychology491.