PSYC 390 & PSYC 392
Application Form
Print and complete this form then submit it to the Internship Coordinator for review. And while you're here, print out the
faculty recommendation form twice.
Please Print Information Below Part I:
Student Information
| 1 | _________________ Last Name | __________________ First Name | __________________ |
| 2 | _________________ | ___________________ | __________________ |
| Declared Major | Phone Number | Social Security Number |
Anticipated Internship Enrollment Date (Semester/Year): ______
Anticipated Graduation Date: (circle one and fill in year)
January, 20 _____or May, 20_____
Which Internship are you applying for?
_____ 390 (Human Services) ____392 (Applied Psychology)
The following courses must be completed before you enroll for the internship. Please list the semester/year you have taken the course or plan to take the coure, the instructor & the grade you received.
| course: | semester/year | instructor | grade |
|---|---|---|---|
| Psych 304 | _______________ | _______________ | ____________ |
| Psych 306 | _______________ | _______________ | ____________ |
The internship course may subsititute for the 2nd lab requirement in psychology. You are expected to have completed a Psychology lab class prior to enrolling in Psych 390 or 392. Please identify the lab you have taken (or are taking) and when you completed (or will complete) it.
| course: | # | semester/year | instructor | grade |
|---|---|---|---|---|
| Lab 1: | ________ | _____________ | __________ | _______ |
Psych 390 and 392 require commitments of 100+ hours to a work site. It is important that your schedule will permit this degree of commitment. Please check the following statement ONLY if it is true:
_______My schedule (work and school) will definitely allow me the necessary time for Psych 390 or 392.
NOTE: You will be notified via e-mail when your application has been reviewed by the internship coordinator.
Part II:
Personal Narrative-please prepare on a separate page(s) and staple to this form. (Maximum length=2 typewritten, double-spaced pages).
Please briefly discuss what you hope to gain from this internship experience and how this internship experience fits into your future plans.
Describe your academic plans after graduation, indicating whether you plan to attend graduate school (your planned area of study, and the degree you are seeking).
Please describe your goals for the internship. Discuss any experiences you have had that related to or may have prepared you for this type of internship experience (e.g., courses, research team experience, work experience, volunteer work, etc.)
Part III:
You are required to obtain recommendations from TWO Psychology faculty members, one of whom should be a Psych 304, 306 or Psych lab instructor. Recommendations must be made using the recommendation form.
These forms should be returned by the faculty members directly to the internship coordinator (instructions are with recommendation form). Because your application will not be complete until these recommendations are received, please be sure to give these forms to the faculty members whom you are asking for a recommendation at least two weeks before the time you wish your application to be reviewed.
Applications must be received at least two weeks prior to the beginning of the registration period for the semester you wish to enroll in Psych 390 or 392. Space is limited; applications will be evaluated in order of receipt with attention given to the following:
Class rank (seniors have first priority)
Completion of Required Courses (e.g., 304, 306)
Personal Statement (Part II)
Recommendations of Faculty (Part III)
Grade Point Average
Send this form (Parts I and II) to:
John Edwards, Ph.D.
Internship Coordinator
Department of Psychology
6525 N. Sheridan Rd.
Chicago, IL 60626
(773) 508-3025
e-mail: jedward@luc.edu
