Summer Program on Mind and Brain

Mind and Brain Home Page

Program Description

Mentors

Research Laboratories

Application Info and Form

Recommendation Form

Behavioral Neuroscience Program

Cognitive Psychology Program

Dept. of Psychology

CSU Home Page

Application Form

Due Date: March 1, 2008

Please fill in all fields in this form, unless otherwise instructed. For fields that do not apply to you, enter “NA”. We strongly encourage you to prepare your longer statements in a word processing program on your computer and then paste them into the box provided.

Personal Information

Title:	Mr. Mrs. Miss Ms.
First Name:
Last Name:
Email Address:
Birthdate:
U.S. Citizen or permanent resident?	Yes No
Gender:	Male Female
Ethnicity (check all that apply):	African American, not of Hispanic Origin
	American Indian or Alaskan Native
	Asian or Pacific Islander
	Caucasian/White, not of Hispanic Origin
	Hispanic
	Other
	I do not wish to provide this information

Current Address

Street Address:

Street Address 2:

City:

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Last date you can be contacted at this number:

Permanent Address

Complete this section if your permanent address is different from your current address, otherwise leave blank.

Street Address:

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City:

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Phone Number:

Education

Undergraduate College or University:
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Major:
Currently enrolled as:	Freshman Sophomore Junior Senior
Anticipated semester of graduation:
Do you plan to enroll in graduate school?	Yes No
When?
In what field and subfield (if you have a strong idea)?
Semester you completed an introductory psychology course:
Semester you completed a research methods course (or accepted alternative):
Psychology courses taken with grades as they appear on your transcript:
Science courses taken with grades as they appear on your transcript:
Cumulative GPA (on a 4.0 scale):
Summary of research experience, if any:

References

Provide the names of two professors who know you well and will submit letters of recommendation. You must provide an e-mail address. We will e-mail the professor with a request for a letter of recommendation for you.

First Reference

First Name:

Last Name:

Email:

Second Reference

First Name:

Last Name:

Email:

Desired Research Mentors

Select up to three professors in our program whose research most interests you and and whose group you would like to join for the summer.

Choice One:	Anne Cleary Ben Clegg Deana Davalos Ed Delosh Dave McCabe Patrick Monnier Matt Rhodes Carol Seger Lucy Troup Vicki Volbrecht
Choice Two:	No second choice Anne Cleary Ben Clegg Deana Davalos Ed Delosh Dave McCabe Patrick Monnier Matt Rhodes Carol Seger Lucy Troup Vicki Volbrecht
Choice Three:	No third choice Anne Cleary Ben Clegg Deana Davalos Ed Delosh Dave McCabe Patrick Monnier Matt Rhodes Carol Seger Lucy Troup Vicki Volbrecht
What interests you about these potential mentors? (300 words or less)

Statement of Interest

What do you hope to do after you graduate with your bachelor's degree and what are your long-term career goals? What do you hope to gain from the research experience in our summer program, and how might this experience help you attain your career goals? (500 words or less)

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CLICK THE SUBMIT BUTTON BELOW TO SEND YOUR APPLICATION

Note that there is no way to save your work and then come back to it later, nor is there any way to revise your responses after they’ve been submitted. Make sure you have completed the entire form and are happy with your responses before clicking the submit button.

Department of Psychology

Colorado State University

Fort Collins, CO 80523

Phone: 970.491.6363

Fax: 970.491.1032

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