Applied Cognition And Neuroscience Exit Interview Form

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Applied Cognition and Neuroscience Exit Interview Form
(A copy of the Official ACN Degree Plan must be attached to this Interview Form)
(Submit this form one semester before the semester of graduation)
1. Student ID Number _________________________
_______________________________________________
____________________________
Today’s Date
Name
Cognition
Neuroscience
Cog-Neuro
HCI IONM Modeling
____________________________
Circle one of the Above 6 Specialization Areas
Expected Graduation Date
_____________________________________________________________________________
Current Home Address
_______________________________________________
___________________________________
Current Home Phone Number
Current Home Email
____________________________________________________________________________________________
Future Home Address
_______________________________________________
___________________________________
Future Home Phone Number
Future Home Email
______________________________________________________
Start Date:____________________
Future Job Position Title
____________________________________________________________________________________________
Future Work Address
_______________________________________________
___________________________________
Future Work Phone Number
Future Work Email
Knowledge Question QK:
Value of ACN Program Experience for increasing
No
Little
Valuable Very
knowledge of your chosen specialization area.
Value
Value
Valuable
Method Question QM:
Value of ACN Program Experience for increasing your
No
Little
Valuable Very
knowledge of methodological techniques relevant to your
Value
Value
Valuable
chosen specialization area.
Work Experience Question QE:
Value of ACN Program Experience for increasing your
No
Little
Valuable Very
work experience in your chosen specialization area.
Value
Value
Valuable
Career Question QC:
Value of ACN Program Experience for increasing
No
Little
Valuable Very
likelihood of pursuing post-graduate work in chosen
Value
Value
Valuable
specialization area.
Revised: 12/8/2011
Applied Cognition & Neuroscience Exit Interview

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