PSY499 Independent Study Application
Please print legibly.
1.
Name:
Date:
2.
Address:
3.
Phone Numbers:
a.) Home
b.) Work
c.) Cellular
4.
E-mail Address:
5.
UH Student ID# or Social Security Number:
6.
What is your expected date (i.e., semester and year) of graduation?
7.
Major:
8.
Cumulative GPA:
Psychology GPA:
9.
Desired semesters of enrollment (e.g., Spring 2010 AND Summer 2010)?
and
If applicable, Minor(s):
11. Please indicate the following courses that you have completed by writing the letter grade
you have received in that specific course next to that specific course. If you are currently
enrolled in any of the specific courses below, please write the initials ‘CE’ (currently
enrolled) next to that specific course. If you have completed any of these courses at an
institution other than the University of Hawaii at Manoa, please indicate that you have
done so by writing that institution’s name in parenthesis after the course name.
a)
b)
c)
d)
e)
f)
__________ Exceptional Child (Abnormal Child Psychology
__________ Abnormal Psychology
__________ Developmental Psychology
__________ Methodology
__________ Introductory Statistics
__________ Computer Course; List Course Title: ___________________
May 2008
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12. Please list all other psychology courses, along with your letter grades, that you have
completed. If you have completed any of these courses at an institution other than the
University of Hawaii at Manoa, please indicate that you have done so by writing that
institution’s name in parenthesis after the course name.
13. Describe any prior research experience you may have had. Include location and type of
responsibilities you performed.
14. Please describe any computer experience you may have had.
15. Please describe your short-term interests and how they are related to independent study.
Be sure to articulate your goals and how you think this course might help you reach them.
16. What are your long-term interests/career goals?
Please contact Dr. Brad Nakamura by e-mail at bradn@hawaii.edu to set up an appointment for a
brief interview.
Please bring this application with you to the interview.
For office use only
Date of Interview:
Approval Code:
October 2010
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PI Signature: