Student’s Name
Date
Semester expected to graduate: FALL / SPRING 20____.
Declaration of Allied Field
This form, the Declaration of Allied Field, and the Declaration of Major form must be
turned in to the Registrar’s Office (Eliot 311).
Intended Allied Field:
____ Arts and Literature
____ Biological, Physical & Computational Sciences
____ Cognitive Science
____ Cross-Cultural Studies
____ History & Social Sciences
Please list the six units you have taken and/or plan to take to satisfy the department’s
requirements for this Allied Field. Changes to this plan must be approved by your
advisor and an updated version of this declaration filed with the department.
Dept. & Course #
Course Title
1.
2.
3.
4.
5.
6.
(over)
Have Taken
Plan to Take
For each course you listed, please explain, in a sentence or two, the likely connection
between that course and your work in psychology (including, if you wish, your likely
direction for a thesis.) If this is an updated plan, justify only the change you are making.
Also, please list the psychology classes that you have taken or plan to take.
Faculty Advisor Signature
8/8/11