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___________
Application for
Undergraduate
DIS (DIRECTED
INDIVIDUAL STUDY)
Department of
Psychology
1. You MUST
be a Junior or Senior
2. You should have
already completed 12 hours of Psychology courses before enrolling in DIS*
3. Only one DIS is permitted in a given semester
unless special permission is granted.
4. You may take a maximum total of 12 credit
hours of DIS (PSY 4911-4914) and/or Research Topics (PSY 4920).
*Can be waived only by approval of your faculty supervisor.
NAME:
___________________________________________________________ SSN: _________-_______-________
SEMESTER
DIS IS FOR: (Summer/A-B-C _____, Spring
_____, Fall ______) Year: _______ _______ #Credit Hrs.
PRIOR
DIS PROJECT(S) FOR WHICH YOU HAVE RECEIVED CREDIT (NOT PSY 4920):
Title:
__________________________________________________ Faculty Supervisor:
_________________________
Title:
__________________________________________________ Faculty Supervisor:
_________________________
Title:
__________________________________________________ Faculty Supervisor:
_________________________
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FACULTY SUPERVISOR:
Please provide a description of the project and the objectives expected
of the student.
.________________________________________________________________________________________________
.________________________________________________________________________________________________
SHORT TITLE OF DIS (up to 20 CHARACTERS long):
_______________________________________________
.
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If “Yes”, you MUST contact Earline
Whitley in 209 PSY for enrollment in the University Medical Monitoring Program.
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Department Medical Faculty
Monitoring Confirmation: _____________________________ Signature:
_____________________________
After receiving the required approval of the instructor, please bring
this form to 209 PSY. After the form has
been processed, you will receive a course reference number that is required FOR
YOU to complete telephone registration, on-line registration, or drop/add.
I
have completed this form and have read the above statement and I understand
that I must register for this DIS myself.
.________________________________
Student
Signature