Child Emotion Research Laboratory
Undergraduate Student Application

This form can be printed, completed and sent to:

Anna Bechner
194 Psychology Building, W J Brogden
1202 W Johnson St
Madison, WI 53706

or you can download the form, fill it out in Word and email it to Anna Bechner
at ambechner@wisc.edu 

Please save it with your last name as the name of the file.

Include an unofficial copy of your transcript.  Please see the registrar’s website on
how to obtain unofficial transcripts:
http://registrar.wisc.edu/students/acadrecords/campus_copy_transcripts.php 
Freshmen may provide a copy of a high school transcript.

Date: _____________________                    Student ID #: __________________________
Name: ______________________________________
Address: ______________________________________________________________
Telephone: ____________________         E-mail: ______________________________
Major: _______________________    Overall GPA: ________ Major GPA: __________
Semesters Completed:__________    Expected Graduation Date: ______________
How many hours/research credits are you interested in? ____________
If you are responding to a specific research posting for this lab, please list the name
of the contact person: __________________________________________________________

Computer Background: Please list the operating systems, software, or programming languages
with which you are familiar:

Experience and Academic Interests

Please provide a brief description of your academic interests:

What kind of research are you most interest in?

Briefly, what are your goals after graduation:

Please describe any previous experience you have working with children:

Do you have prior laboratory experience?: ___________
If so, which lab(s)?: _______________________________________________________

Have you completed any of the following courses? (Note honors courses with an "H"):
Abnormal Psychology: __________               Child Development: __________
Experimental Psychology: __________         Behavioral Neuroscience: __________

Please list the jobs (paid and volunteer) you have had:
Job Title/Description                       Dates of Employment                      Employer/Contact person
__________________________________________________________________________________

References
Please list two academic or work-related references (another professor, previous employer, advisor) we may contact:

Name: __________________________________ Title: __________________________
Phone: ___________________ Email: ________________________________________
Relation to you: __________________________________________________________

Name: __________________________________ Title: __________________________
Phone: ___________________ Email: ________________________________________
Relation to you: __________________________________________________________

SCHEDULE

Please place an "X" after times when you know you cannot work in the lab:

*Please note: Children attend school during the day. Most of our work with children occurs
between the hours of 3pm-6pm, and on weekends. All lab assistants will be required to
work some weekends.

Semester: ___________ Year:__________