University of North Texas

School of Library and Information Sciences

Practicum Application
Digital Imaging Only

To be accepted in this course you must complete this application in its entirety. You will be placed in a practicum setting after you have registered for the course.

Applying for:     Fall           Spring           Summer                                  Date                           

Name                                                                      Social Security #                                         
                   Last                                          First

Address                                                                      Home Phone                                           
                         Street
                    
                                                                                  
                         City                         State                         Zip

Employer/Institution                                                    Work Phone                                             

E-mail address                                                        

Location preference:(specify)                                                                                                                           

Is transportation a consideration? YES NO

If yes, explain:
                                                                                                                                                       

If you have a disability that will require special accommodation contact the Practicum Director to provide appropriate information prior to the assignment.

A list of all coursework and complete grades must be attached.

Attachment of this material is mandatory in order to proceed with the application.

 

Applicants: Do Not Complete This Section

 

Placement assigned:                                                                                                                  

Supervisor:                                                                                                                                    

Agency Head:                                                                                                                                

Address:                                                                                                                                        

Phone Number:                                                                                                                            

Number of Clock Hours: 120

Time: To be arranged

 

Submit this form to:

Dr. Samantha Hastings
UNT School of Library and Information Sciences
P.O. Box 311068
Denton, TX  76203