UHD

University of Houston – Downtown

Career Services

FIELD EXPERIENCE APPLICATION

(Attach resume and UHD Grade History before submitting to professor in your academic department—see listing)

Part 1 (Student):

Last Name:_____________________First_______________ Student ID Number: ________________________

Address:_________________________________________ City, State, Zip: _______________________________

Day Telephone: ___________________________________ Evening Telephone: ___________________________

Major: ___________ Hours Completed: ______Overall GPA: _____ Graduation Date: ______________________

Email: ___________________________________________________***(all contact via email, disable junk or bulk function for email from UHD)***

Semester: Fall _____ Spring _____ Summer_____

F-1 students must receive approval from the Coordinator of International Admissions, Suite 350 South (713) 221-8048.

Signature: __________________________________ Date: _____________________________________

Part 2 (Employer): JOB DESCRIPTION

During the ___________ semester of 200__, ________________________________ will be participating in a cooperative program between you and the University of Houston – Downtown. As the employee’s direct supervisor, please provide a brief description of student duties or attach a copy of the job description:

______________________________________ __________________________________________

Student’s Position Title Department

Summary of Responsibilities:

Please check all that apply to this Field Experience:

Internship/Co-op ______ Volunteer______ Permanent______ Full-time ______ Part-time _____ Temporary ______

Paid ______ Unpaid ______

(Please Print or Type)

______________________________ _____________________________ __________________________________

Name of Student’s Supervisor Email Address Organization

______________________________ _____________________________ __________________________________

Title Telephone Address

______________________________ _____________________________ __________________________________

Signature Fax City, State, Zip

Part 3 (Academic Department Approval): Approved:______ Denied:______

Signature: ___________________________________________________ Date:_____________________________________ Print Name and Title: Dr. Susan Henney, Social Science Internship Coordinator