Fillable WORK EXPERIENCE AND INTERNSHIP PROPOSAL (San Diego Mesa College)

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WORK EXPERIENCE AND INTERNSHIP PROPOSAL (San Diego Mesa College)

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San Diego Community College District
3375 Camino del Rio South
San Diego CA 92108-3883
1
WORK EXPERIENCE AND INTERNSHIP PROPOSAL
A maximum of 8 units can be claimed salary advancement by faculty members during their
entire careers at SDCCD.
Date:
Name:
College/Center Assignment:
ID#:
I understand that I will turn in a copy of this form with my Professional Development Proposal.
I understand I will keep the original of this form and when I've completed my work experience I will get
my employer's original signature on this form and turn it in with my Report of Completion.
Name of Employer
Address
Nature of Business
How will this work further my role on campus?
Name of Supervisor
Description of service to be rendered
Title of Position/Job
Mailbox Location (Mesa Only):
I have previously received credit for a work project. Yes No
If your answer is yes, please complete the following:
Nature of Work Experience
Print Form
San Diego Community College District
3375 Camino del Rio South
San Diego CA 92108-3883
2
(Work Experience and Internship Proposal)
Period of employment:
From
To
Semester units of credit received:
Faculty member: Please note that the following must be an original signature from your employer,
so please be sure to take this form with you during your Work Experience. Faxed copies are not
acceptable.
This is to certify that was employed by us from
to for hours per day, days per week
and that the nature of this employment was as represented above.
I hereby certify that I will not claim credit for any other activities undertaken during the period covered
by this Proposal, except for those credits which may be allowed for the Work Experience Project itself.
I also certify the the organization or business enterprise which will be my employment is not self-owned,
or self-operated.
After Work Experience has been Completed
VERIFICATION OF WORK EXPERIENCE PROJECT
(Make a copy of page 1 to serve as the employer certification which must be attached to the
completion report)
Title Signature
Date
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WORK EXPERIENCE AND INTERNSHIP PROPOSAL (San Diego Mesa College)

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Completed 25 July 2020

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