Applied Animal Behavior Practicum Application
Contact Information
Name
E-mail address
Educational Information
Current Year (SO, JR, SR)
Current GPA
Grade received or expected in PSY 360
AND/OR Grade receive or expected in PSY 1400
When are you interested in taking the practicum? (sem/yr)
Will this be your first practicum or an additional one?
Other activities
Will you also have a job while you are taking the
practicum? (mark one)
If yes, how many hours per week will you be working?
Are your work hours set or variable?
____ YES
____ NO
______ hours
____ set
_____ variable
Can you commit to working 2 consecutive hours (Fall/Spring) or 4 consecutive hours (Summer I) each
day Monday through Friday, between the hours of 8:30AM and 4:30PM?
(mark one; If no, please explain)
____ Yes I can work the required hours as described
____ No I cannot work the hours required as described because:
With your upcoming class and work schedule, are you available Tuesdays AND/OR Wednesdays
evenings from 5:00pm – 7:00pm?
____ I will be free Tuesdays ONLY from 5pm – 7pm
____ I will be free Wednesdays ONLY from 5pm – 7pm
____ I will be free Tuesdays AND Wednesdays from 5pm – 7pm
____ I will be free NEITHER Tuesdays NOR Wednesdays from 5pm – 7pm
Physical limitations
Are you able to fully use your arms / legs for handling and walking animals? ___ Yes ____ No
Do you have any physical disability which prevents you from lifting 40lbs?
____ Yes ____ No
Do you have any physical disability which prevents you from standing for two hours, sitting on the
floor, or crouching?
____ Yes ____ No
Experience with dogs
Please describe what, if any, experience you have working with dogs (e.g., family pet, volunteer
experience, etc.)
Interest in the practicum
Please explain why you are interested in taking this practicum.