Student’s Name:
SE ID (SO#######):
Local Address
Local Phone
Expected Date of Graduation
Semester you desire an internship/practicum
Type of internship/ practicum you desire
Preference of internship/ practicum location
Hours completed toward a degree
Campus GPA
Mass communication hours in option (e.g. TV/Film; Advertising) BEYOND core courses Do NOT include: MC101, MC201, MC301, MC401 or UI382 Course #     Title     Grade      Semester/Year Taken
Mass communication GPA
Pertinent Work Experience: Position   Company Name/Address    Dates      Supervisor
Special Skills (computer, FCC License, writing ability, art ability, etc.):
Career Goal (list):