This form will be submitted to the Psychology Department and will become a part of your advising packet.

Name:          Date:

Current year in school  Select One Freshman Sophmore Junior Senior Graduate Other No. of credits completed      Cumulative GPA

Previous Major(s)

Previous Minor(s)     Intended Minor(s)

Intended date of graduation          Transfer Student ?  Yes No

Previous university or institution

(If you have previous coursework, please list the psychology courses you have completed elsewhere):

Are you interested in the  BA or BS (select one)

Other program options in which you may be interested: Select one if interested Gerontology Dual Degree: Psychology/Occupational Therapy

Tentative Career Interests:  What are your tentative plans upon graduation?

Get a job in my field
Get a job to earn some money and then apply to graduate school
Go to graduate school
Take a year off and travel
Go into the Peace Corp or Americorp or other organization
Other (please specify)

If graduate school is in your future goals immediately or at some later point in time, please answer the following questions:

Type of program: Select One Master's Degree Doctorate Degree Both Other Don't Know

Tentatively, in what field of study would you pursue graduate work?

Other information about you that might help as we advise you?