REQUEST FOR APPROVAL OF Practicum (For Certificate in ...



REQUEST FOR APPROVAL OF Practicum (For Certificate in CT or MAIS-CCT)

Student G#

Requests approval of the practicum described below:

Title: CTCH 685 Practicum

Practicum Site

Organization

Practicum Mentor (Name/Title)

Semester and year to be taken

Practicum Proposal should include the following:

1. A statement of purpose and rationale;

2. A description of workplace responsibilities;

3. A description of how the purpose of the practicum will be accomplished;

4. A description of the criteria against which the supervisor/mentor will evaluate the practicum; and

5. A plan of work (minimum of 200 hours for three credits, this includes research and writing hours).

Required Signatures:

Student Date

Knowledge Area Advisor Date

Practicum Mentor Date

Director of Academics Date

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