PSY 4949: Community Work in Psychology Registration Request Form
Department of Psychology, University of Florida
Before submitting this form, please carefully read and confirm you understand ALL of the following:
Registration request forms for PSY 4949 are managed by the Psychology Dept. Advising office. Completed forms should be
submitted before the end of the Drop/Add period of the semester requested. Students must have registered for at least one credit
hour in ANY course before the Drop/Add period begins, or they will be assessed a $100.00 late fee when registered. To be
registered after the Drop/Add period has ended, you must bring this completed form and meet with a Psychology Dept. advisor
in person to complete the registration process.
This course is graded S/U only. PSY 4949 may be taken for 1-3 credits per semester. For each credit taken, students must
complete 45 hours of work during that semester. Only a maximum of 4 credits of PSY 4949 will be counted toward my
psychology major. Students will not be registered for this course if they have current registration holds or if information entered
on this form is illegible or incomplete.
Student’s Assurance: I have read and understand the A.P.A.’s Ethical Principles as they relate to this project.
I understand that it is my responsibility to ensure that my Project Supervisor for the Agency returns my grade evaluation to the
Psychology Undergraduate Advising Office at the end of the semester.
Student Signature:_____________________________________________ Date: ________________________
By signing, I confirm that I have read and understand all of the information provided in this form.
STEP 1: STUDENT & REGISTRATION INFORMATION
Name: ______________________________________
UFID: _____________ - _____________
UF Email Address: ____________________________
SEM: _________YEAR:________ CREDITS: _______
(if Summer, indicate A/B/C)
STEP 2: AGENCY CONTACT INFORMATION
Meet with the Community Agency Volunteer Supervisor in person to discuss the requirements for your volunteer
service, including (but not limited to) ethical concerns. NOTE: Only those Agencies and Supervisors listed as approved
on the Psychology Department website may serve as a Supervisors for volunteer credit hours.
Volunteer Supervisor (Print): _______________________________
Job Title: ________________________________
Agency: _______________________________________________ Supervisor Phone: ____________________________
Volunteer Supervisor Work Email Address: ________________________________________________________________
Project Supervisor’s Assurance: “I agree to supervise the student for the work provided by my agency. For each credit the
student will complete 45 clock hours of volunteer work. All volunteer work will be unpaid time.”
Supervisor Signature:____________________________________________
Date: ________________________
STEP 3: DEPARTMENT APPROVAL & REGISTRATION
After completing Steps 1 & 2, bring this completed form to the Psychology Undergraduate Advising Office in
Room 135 of the Psychology Building for review. Correctly completed forms will be processed by advising staff.
- - - - - - - - - - - - - - - - - - - For Office Use Only. Do Not Mark Below! - - - - - - - - - - - - - - - - - - -
SECTION: __________
________________________________________________
Undergraduate Coordinator Signature
Date Processed
IF AFTER DROP/ADD = ALSO: CHECK BOX
REGISTERED BY: __________
ADDED TO EXCEL BY ______________
AND Dept/Ctl ADDED BY:________ Comment/Except ADDED BY:_______
FILE PATH: L:\Advising\INDIVIDUAL WORK COURSES\IW Forms\PSY4949