This form is an optional worksheet for preparing the online application. Do not submit this form in lieu of the online application. However, you may find it helpful for preparing your online application in GAMES.

UNIVERSITY OF NEBRASKA-LINCOLN

DEPARTMENT OF PSYCHOLOGY APPLICATION

WORKSHEET FOR ONLINE APPLICATION

Current Phone: ______

NAME: ______Work Phone: ______

SS* ______Perm. Phone: ______

Current Address ______BA Degree: ______

City/State/Zip ______(Granting Institution) (date)

Perm. Address: ______MA Degree: ______

City/State/Zip ______(Granting Institution) (date)

E-mail Address ______-

Date of Birth*: ______Gender*: [ ] Male [ ] Female

Indicate Race/Ethnicity* [ ]White/Non-Hispanic [ ]Black/Non-Hispanic [ ]Hispanic [ ]American Indian/Alaskan Native [ ]Asian/Pacific Islander

Check as appropriate: [ ] Minority [ ] Disabled [ ] International

*UNL does not discriminate in its academic, admissions or employment programs and abides by all federal regulations pertaining to the same. (The furnishing of race/ethnic, sex, age and disability information is not an admission requirement. The data are used for Federal Reports.)______

Citizenship (Non U.S. Citizens) Country of Citizenship ______Birthplace: ______

(city) (country)

Type of Visa Expected: ___ F-1 (1-20, student) ___J-1 (IAP-66, exchange visitor) Attach copy of current IAP

___F-2 (dependent) ___J-2 (dependent) ___Permanent Resident Attach Copy Form 134 ______Other (specify)

ALL APPLICANTS: CHECK THE PROGRAM TO WHICH YOU ARE APPLYING

For Law Psychology, please check one in the specialty area, AND one in the degree area below.

[ ] NEUROSCIENCE & BEHAVIOR Designate ONE Specialty Area Designate ONE Degree Track

[ ] CLINICAL [ ] Neuroscience & Behavior [ ] JD-Ph.D.

[ ] COGNITIVE [ ] Clinical [ ] Ph.D-MLS

[ ] DEVELOPMENTAL [ ] Cognitive [ ] JD-MA

[ ] LAW/PSYCHOLOGY [ ] Developmental

[ ] SOCIAL-PERSONALITY [ ] Social-Personality

GRE SCORES: (DATE: _____) V ______Q ______Written ______SUBJ______L/SAT(Law/Psych only)_____

GPA: Undergraduate GPA_____ Masters GPA_____

LIST TRANSCRIPTS: 1)______LIST LETTER WRITERS 1)______

(send 1 ORIGINAL 2)______(3 required) 2)______

of each) 3)______3)______

4)______4)______

1.  PERSONAL STATEMENT: Please include a personal statement with your application material that addresses each of the following questions:

a.  What are your interests in Psychology (or Psych and Law, if applicable)?

b.  What are your long-range career goals? In other words, what kind of work do you hope to be doing in 10 to 15 years?

c.  What are your research interests? What research experiences have you had? Be sure to indicate any faculty in the psychology department with whom you share research interests and with whom you would be interested in working.

d.  Are there internships, jobs, practicum, or other experiences relevant to your application?

e.  Are there any other unique factors that we should consider in evaluating your application?

2.  In a separate document, please list all relevant courses (e.g., psychology, statistics, biology, neuroscience, etc.) you have taken post high school. Indicate a descriptive title (e.g., “Experimental Psychology” NOT “Psych. 7852”). Please use the following format:

Descriptive Course Title Grade Institution

______

3.  In a separate document, please list faculty members with whom you would be interested in working.

(Required for Clinical Psychology applicants, optional for others).

4.  In a separate document, please list any papers presented or published (if applicable).