PSY 472/572 -- Fall 2009
Please use the PRINT command in your web browser to print a copy of this form,
fill it out, and return to Jennifer Freyd's mailbox in Straub Hall (ask the department
secretary to put the form in the correct mailbox or send via campus mail to "Jennifer
Freyd, Psychology").
Note, do not send electronic versions: only hard copy applications turned
in as instructed can be considered.
1. Today's Date:
2. Do you want to take Psychology of Trauma course for credit or audit? CREDIT
472___ CREDIT 572___AUDIT____
(Applications are required whether you wish to register or simply
audit. Students who wish to register will have priority if there are
more applicants than space available.)
3. Name:
4. Student ID number:
5. Email:
6. Phone number(s):
7. Campus mail or home address:
8. What is your student status? undergraduate student_____; graduate student_____; other____________ (please specify)
9. What is your year in the program?____________
10. Graduate or Major Department:
11. Educational and Career Goals:
12. Have you had a statistics course (e.g. Psy 302)? If so, when did you take the course, what was the course, and who was your instructor?
13. Have you had a research methods course (e.g. Psy 303)? If so, when did you take the course, what was the course, and who was your instructor?
14. What other courses have you taken (if any) that you believe prepare you for taking Psychology of Trauma?
15. What work, volunteer, or other experience (if any) do you have that prepares you for taking Psychology of Trauma?
16. Why do you want to take this course? What do you hope to get out of it? What suggestions or concerns do you have?