Loyola University New Orleans

Psychology A499
Independent Studies
Dr. Kim Ernst



Indicate the semester and the year that you are interested in taking Psychology A499.

Fall __________ Spring __________ Summer __________

Are you interested in enrolling in this course for two consecutive semesters?  (   ) Yes   (   ) No

Name: ____________________________________________________________    Date: __________________

Social Security number: __ __ __ - __ __ - __ __ __ __

Current telephone number:  (home) _____________________ (other) ___________________

E-mail address: _______________________________________________________________________________

Local address: ________________________________________________________________________________


Permanent address: ____________________________________________________

Permanent phone number:  ______________________________________________


Current Academic Classification:  _________________________________________

Major: _____________________________    Minor: __________________________

Cumulative GPA: ____________________     Psychology GPA: __________________


Please list below psychology courses completed (if not at Loyola University, indicate where):

___________________________         _________________________        ________________________

___________________________        __________________________       ________________________

___________________________        _________________________        _________________________


Why do you want to enroll in Psychology A499?

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

What are your short- and long-term educational goals?

____________________________________________________________________________________________

____________________________________________________________________________________________


What computer skills do you have? 

_____________________________________________    _____________________________________________

_____________________________________________    _____________________________________________

_____________________________________________    _____________________________________________

Do you know how to use PsycLIT or PsycInfo?    Yes (    )    No (     )


Do you have any work experience? If so, please provide dates and type of employment.

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


For scheduling purposes, please indicate those times that you WILL be available during the semester(s) that you are interested in enrolling in Psychology A499. Also indicate those times that you will attend classes.

Time

Monday

Tuesday Wednesday Thursday Friday
 8:30-9:30

 

 

 

 

 

 9:30-10:30

 

 

 

 

 

10:30-11:30

 

 

 

 

 

11:30-12:30

 

 

 

 

 

12:30-1:30

 

 

 

 

 

 1:30-2:30

 

 

 

 

 

 2:30-3:30

 

 

 

 

 

 3:30-4:30

 

 

 

 

 

 4:30-5:30

 

 

 

 

 

 5:30-6:30

 

 

 

 

 


Use the space below to provide any additional information you deem relevant to your application.

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Psychology A499

Ernst's home page

Psychology Department

Loyola University


Last Update: 2003-08-30