University of Nebraska-Lincoln
Department of Psychology
Research Assistant Application
Applicant Information
Last Name / Click or tap here to enter text. / First / Click or tap here to enter text. / Date / Click or tap to enter a date.Street Address / Click or tap here to enter text.
City / Click or tap here to enter text. / State / Click or tap here to enter text. / ZIP / Click or tap here to enter text.
Phone / Click or tap here to enter text. / E-mail Address / Click or tap here to enter text.
Student Status / Freshman ☐ / Sophomore ☐ / Junior ☐ / Senior ☐ / Post-B.A. ☐
Date of Birth / Click or tap to enter a date. / Current Age / Click or tap here to enter text. / Blackboard ID / Click or tap here to enter text.
Are you available to attend lab meeting on Mondays between 10am-11:30am? / YES ☐ / NO ☐ / If no, explain / Click or tap here to enter text.
Can you commit to working 8 hours per week in the lab? / YES ☐ / NO ☐ / If no, explain / Click or tap here to enter text.
Can you make at least a 2 semester commitment to the lab? / YES ☐ / NO ☐ / If no, explain / Click or tap here to enter text.
Have you ever been convicted of a felony? / YES ☐ / NO ☐ / If yes, explain / Click or tap here to enter text.
Education
High School / Name of School: Click or tap here to enter text.From
(Year) / Click or tap here to enter text. / To
(Year) / Click or tap here to enter text. / GPA / Click or tap here to enter text. / Academic Honors / Click or tap here to enter text.
College / Name of School: Click or tap here to enter text.
From
(Year) / Click or tap here to enter text. / To
(Year) / Click or tap here to enter text. / GPA / Click or tap here to enter text. / Major / Click or tap here to enter text.
College / Name of School: Click or tap here to enter text.
From
(Year) / Click or tap here to enter text. / To
(Year) / Click or tap here to enter text. / GPA / Click or tap here to enter text. / Major / Click or tap here to enter text.
College / Name of School: Click or tap here to enter text.
From
(Year) / Click or tap here to enter text. / To
(Year) / Click or tap here to enter text. / GPA / Click or tap here to enter text. / Major / Click or tap here to enter text.
PROFESSIONAL References
Please list two academic references or employers. These people may be contacted regarding your past work performance.Full Name / Click or tap here to enter text. / Relationship / Click or tap here to enter text.
Company / Click or tap here to enter text. / Phone / Click or tap here to enter text.
Email / Click or tap here to enter text.
Full Name / Click or tap here to enter text. / Relationship / Click or tap here to enter text.
Company / Click or tap here to enter text. / Phone / Click or tap here to enter text.
Email / Click or tap here to enter text.
RESEARCH, PROFESSIONAL, AND VOLUNTEER EXPERIENCE
Please prioritize listing any research activities you have been involved in, but also list any other work or volunteer experiences that might be relevant.Position / Click or tap here to enter text. / Start Date (MM/YEAR) -
End Date (MM/YEAR) / Click or tap here to enter text.
Brief Description of Your Role and Relevant Training and Experience / Click or tap here to enter text.
Position / Click or tap here to enter text. / Start Date (MM/YEAR) -
End Date (MM/YEAR) / Click or tap here to enter text.
Brief Description of Your Role and Relevant Training and Experience / Click or tap here to enter text.
Position / Click or tap here to enter text. / Start Date (MM/YEAR) -
End Date (MM/YEAR) / Click or tap here to enter text.
Brief Description of Your Role and Relevant Training and Experience / Click or tap here to enter text.
PSYCHOLOGY AND/OR STATISTICS COURSES
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
Course / Click or tap here to enter text. / Semester-YR / Click or tap here to enter text. / Grade / Click or tap here to enter text.
SkILLS Select level of experience from drop-down menu
MS Excel Choose an item. / SPSS Choose an item. / SAS Choose an item. / Mplus Choose an item.Qualtrics Choose an item. / Data Entry Choose an item. / Data Analysis Choose an item. / Recruitment Choose an item.
Clinical Interviewing
Choose an item. / Behavioral Observations
Choose an item. / Independent Research Project
Choose an item. / Literature Review
Choose an item.
Other Relevant Skills: / Click or tap here to enter text.
Why are you interested in the Family Development Lab? What do you think you could contribute to the lab? What experiences do you hope to have working in the lab?
Click or tap here to enter text.Disclaimer and Signature
By checking this box, I certify that my answers are true and complete to the best of my knowledge. ☐Please submit this application to Rebecca Brock, Ph.D., Director of the Family Development Lab:
· Email to
· Drop off at the front desk in the psychology office (238 BURN)