INFORMED CONSENT DOCUMENT



Undergraduate Research Team Application

Visual Recognition & Object Memory [VROM] Lab

042 Armstrong Hall • Psychology Department • Minnesota State University, Mankato

Lab Director: Moses M. Langley, Ph.D. • 030 Armstrong Hall • moses.langley@mnsu.edu



Basic Information

|Name: [pic] |Date of application: [pic] |

|Phone: [pic] |E-Mail: [pic] |

|Major(s): [pic] |Year in school: (Click to change) |

|Major GPA: [pic] |Overall GPA: [pic] |

Estimated date of graduation: [pic]

When would you like to join the lab? (semester/year) [pic]

Experience

Courses Taken

| Statistics | Cognitive Psych. | Learning | Human Memory |

| Research Methods | Cognitive Neurosci. | Sensation & Percep. | Drugs & Behavior |

| Biopsychology | Behavior Genetics | Neurobiology | Computer Science I |

If Statistics (Psychology 201), who was your instructor? [pic]

If Research Methods (Psychology 211), who was your instructor? [pic]

Prior or Current Research Experience

| Yes | No |

If yes, identify the lab(s) you worked in, the duties you performed, and the duration of your involvement: [pic]

Skills

Please rate your proficiency in the following areas:

1 = No experience, but I’ll learn 2 = Some experience 3 = Enough experience to work independently 4 = A lot, I could teach you a thing or two!

| |1 |2 |3 |4 |

|PsychINFO, PubMed, Medline, etc. | | | | |

|MS Excel | | | | |

|MS PowerPoint | | | | |

|SPSS | | | | |

|Adobe Photoshop/Illustrator | | | | |

|Visual Studio | | | | |

|E-Prime | | | | |

|Computer Programming (any language) | | | | |

|Web Design | | | | |

Goals

What do you hope to gain by working in the VROM lab?

[pic]

| Yes | No | Unsure |

Do you plan to attend graduate school following your undergraduate degree?

If yes, identify area(s) you would like to study and why:

[pic]

Availability/Time Commitment

How many lab credits would you like to register for?

| 2 | 3 | 4 (not recommended) |

[1 credit = 2-3 hours in the lab per week]

Lab meetings are held Fridays from 10:00a-12:00p. Will you be able to attend?

| Yes | No | Uncertain |

[lab meetings are mandatory]

What weekday hours will you be available to work in the lab?

| |Monday |Tuesday |Wednesday |Thursday |Friday |

|9:00 | | | | | |

|10:00 | | | | |X |

|11:00 | | | | |X |

|12:00 | | | | | |

|1:00 | | | | | |

|2:00 | | | | | |

|3:00 | | | | | |

|4:00 | | | | | |

|5:00 | | | | | |

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