| Student’s Name: | |
|---|---|
| SE ID (SO#######): | |
| Local Address | |
| Local Phone | |
| Expected Date of Graduation | |
| Semester you desire an internship/practicum | |
| Type of internship you desire | |
| Preference of internship location | |
| Hours completed toward a degree | |
| Communication Studies courses and relevant UI courses (301, 345, 423, 425, 504) | |
| Pertinent Work Experience: Position Company Name/Address Dates Supervisor | |
| Special Skills (computer, FCC License, writing ability, art ability, etc.): | |
| Career Goal (list):
Student Signature:_____________________________________Date:________ | |