Human Social Services
Practicum I Application
Student Name ____________________________________________________________
Reliable Contact Information _______________________________________________
Practicum Hours available
8-Noon Noon-5pm after 5 pm
Monday _______ _________ _________
Tuesday _______ _________ _________
Wednesday _______ _________ _________
Thursday _______ _________ _________
Friday _______ _________ _________
Saturday _______ _________ _________
Sunday _______ _________ _________
_____________________________________________________ is a declared Human Social
Services Major, is in good academic standing, and is ready to be admitted to Human Social
Services Practicum I or Human Social Services Practicum II.
Comments:
Signatures:
Human Social Services Advisor
HSS 400 Instructor
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