What can I do to help you as a student and/or as a future mental health professional?
Survey: Learning and Behavior Change
I would like to know more about your interests, needs, and
goals! Please only include information you are comfortable providing and use as much space as you
would like. When you are done, please email this file to me to provide another way we can communicate.
Name: Pronouns:
What are your educational plans?
(MA program, Family Psych or Co-Occurring Disorders program, DA student, considering applying to
PsyD program, etc.)
What are your career goals?
(For example, is there a specific population you’d like to work with? A specific setting you’d like to work
in? Not sure yet?)
Are you completing your practicum this semester? If yes, where? What population are you
working with?
Some students have completed courses in theories of learning, memory, and cognition in their
undergraduate programs but for some students, this material is all new! After reviewing the
topics in the syllabus, where would you estimate that you fall?
A. This is all new to me!
B. Most of this material is new.
C. I learned about a lot of these concepts before, but I don’t feel like I remember them very well.
D. I learned about a lot of these concepts before, and feel confident in my knowledge.
E. I’ve taken upper level courses about learning/memory/cognition and I know this material
extremely well!
Please tell me about yourself so I can get to know you better! What do you think is important for
me to know about you?
What concerns do you have about this class? What else can I help you with?
(For example, “I’m unsure of how I should study,” or “I’m uncomfortable with my Zoom video on”)
Aside from teaching you the course material, how else can I be of help to you? What can I do to help
you as a student and/or as a future mental health professional?
Survey: Learning and Behavior Change
I would like to know more about your interests, needs, and
goals! Please only include information you are comfortable providing and use as much space as you
would like. When you are done, please email this file to me to provide another way we can communicate.
Name: Pronouns:
What are your educational plans?
(MA program, Family Psych or Co-Occurring Disorders program, DA student, considering applying to
PsyD program, etc.)
What are your career goals?
(For example, is there a specific population you’d like to work with? A specific setting you’d like to work
in? Not sure yet?)
Are you completing your practicum this semester? If yes, where? What population are you
working with?
Some students have completed courses in theories of learning, memory, and cognition in their
undergraduate programs but for some students, this material is all new! After reviewing the
topics in the syllabus, where would you estimate that you fall?
A. This is all new to me!
B. Most of this material is new.
C. I learned about a lot of these concepts before, but I don’t feel like I remember them very well.
D. I learned about a lot of these concepts before, and feel confident in my knowledge.
E. I’ve taken upper level courses about learning/memory/cognition and I know this material
extremely well!
Please tell me about yourself so I can get to know you better! What do you think is important for
me to know about you?
What concerns do you have about this class? What else can I help you with?
(For example, “I’m unsure of how I should study,” or “I’m uncomfortable with my Zoom video on”)
Aside from teaching you the course material, how else can I be of help to you? What can I do to help
you as a student and/or as a future mental health professional?
Survey: Learning and Behavior Change
I would like to know more about your interests, needs, and
goals! Please only include information you are comfortable providing and use as much space as you
would like. When you are done, please email this file to me to provide another way we can communicate.
Name: Pronouns:
What are your educational plans?
(MA program, Family Psych or Co-Occurring Disorders program, DA student, considering applying to
PsyD program, etc.)
What are your career goals?
(For example, is there a specific population you’d like to work with? A specific setting you’d like to work
in? Not sure yet?)
Are you completing your practicum this semester? If yes, where? What population are you
working with?
Some students have completed courses in theories of learning, memory, and cognition in their
undergraduate programs but for some students, this material is all new! After reviewing the
topics in the syllabus, where would you estimate that you fall?
A. This is all new to me!
B. Most of this material is new.
C. I learned about a lot of these concepts before, but I don’t feel like I remember them very well.
D. I learned about a lot of these concepts before, and feel confident in my knowledge.
E. I’ve taken upper level courses about learning/memory/cognition and I know this material
extremely well!
Please tell me about yourself so I can get to know you better! What do you think is important for
me to know about you?
What concerns do you have about this class? What else can I help you with?
(For example, “I’m unsure of how I should study,” or “I’m uncomfortable with my Zoom video on”)
Aside from teaching you the course material, how else can I be of help to you? What can I do to help
you as a student and/or as a future mental health professional?
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