First Name *
Last Name *
Permanent Mailing Address *
Telephone number
Email *
Race/Ethnicity	Asian/Pacific Islander Black/African American Hispanic/Latino Mixed Racial Background Native American/Alaskan Native White/Caucasian Other
Student ID
Are you a member of the Psychology Club?	Yes No
Number of credit hours completed (NOT including the present semester) *	00 - 28 Hours 29 - 58 Hours 59 - 88 Hours 89+ Hours
Please check the Psychology courses which you have already completed:	PSYC 101 Introduction to Psychology PSYC 201 Psychology as a Profession PSYC 202 Research Methods in Psychology PSYC 231 Leadership and Human Relations PSYC 232 Sex Roles and Behavior PSYC 233 Psychology of Cinema PSYC 241 Introduction to Human Development PSYC 251 Introduction to Social Psychology PSYC 281 Introduction to Abnormal Psychology PSYC 301 Biological Foundations of Behavior PSYC 302 Behavior Principles
When do you plan to graduate? (Fall YY/Spring YY)
Cumulative overall GPA *
Psychology GPA *
Are you a Psychology major?	Yes No
Do you have a double major?	Yes No
If you have a second major in addition to Psychology, what is your other major?
Please check the Psychology courses in which you presently are enrolled:	PSYC 231 Leadership and Human Relations PSYC 232 Sex Roles and Behavior PSYC 233 Psychology of Cinema PSYC 241 Introduction to Human Development PSYC 251 Introduction to Social Psychology PSYC 281 Introduction to Abnormal Psychology PSYC 301 Biological Foundations of Behavior PSYC 302 Behavior Principles PSYC 331 History and Systems of Psychology PSYC 342 Prenatal and Infant Development PSYC 343 Child and Adolescent Development PSYC 345 Adulthood and Aging PSYC 351 Topics in Social Psychology PSYC 362 Psychological Assessment PSYC 363 Personality Theory PSYC 364 Psychology of Adjustment PSYC 365 Forensic Psychology PSYC 379 Community Psychology PSYC 382 Exceptional Children PSYC 401 Applying to Graduate School PSYC 423 Cognition and Memory PSYC 424 Learning and Behavior Theory PSYC 425 Perception PSYC 426 Physiological Psychology PSYC 474 Behavior Modification
I hereby authorize the Psi Chi Faculty Adviser to review my university records and determine my eligibility for becoming a member of Psi Chi. You will be notified about the status of your application at the E-mail address you have provided. Thank you for your interest in Psi Chi!