DEPARTMENTAL APPLICATION

Office of the Vice Provost for Undergraduate Education

Academic Advisement Center

109 Norton Hall – University at Buffalo

Buffalo, New York 14260

(716) 645-2450 Fax (716) 645-3042

Student must submit UB DARS Report with this application to the Department to which he or she is applying.

Application for a Major in Psychology: B.A. Program ____ OR B.S. Program ____ Date:__________

and a (check if applicable) Joint Major ____ Double Major ____ Double Degree ____ Special Major ____

Minor ____ with _______________________ Department.

Name: ________________________________________ Student or Social Security Number: _________________

Local Address: _____________________________ Permanent Address: _________________________________

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Telephone: ________________________________ Telephone: ________________________________

E-mail address: _________________________________________

Total UB Credits: _________ Total Transfer Credits: _________ Total Credits to date: _________

Transfer Average: ________ UB Average: ________Total Average: ________ Dept. Average: _________

Student’s Signature: __________________________________________ Date: _____________________

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Accepted: _______ Provisionally Accepted:_______ Not Accepted: _______ Entity Code: ________

Departmental Advisor: ________________________________________ Date: _____________________

Comments:

Instructions:

1. Student prints form and completes form with an advisor at Academic Advisement Center or particular

advising office—EOP, CAP, SEAS, MFC, Honors, or Athletes Advising.

2. Advisor forwards application to Christa Greenberg, Department of Psychology, 283 Park Hall, with UB

DARS.

3. Department reviews application and makes a determination.

4. Student is notified of departmental decision.

5. Copies distributed to student; department; Academic Advisement Center.

6. If accepted, original form is sent to Records and Registration.

7. If student is accepted, advising file is forward to Department of Psychology.

8. If student is not accepted, advisor contacts student to reformulate educational plan.