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Independent Practicum Info Sheet
For Independent Practicum, Practicum Project, Directed Studies, Client Projects and other credit-bearing work involving organizations outside of MIIS. This information is for MIIS internal use only.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Permanent Email (Non-MIIS)
*
Your answer
Current Semester
*
Your answer
Organization (if applicable)
*
Your answer
Job Title or Title of Project
*
Your answer
Description of Job or Project (Optional)
Your answer
City
*
Your answer
State or Country
*
Your answer
Street Address (Optional)
Your answer
Supervisor's Name (if Project, Faculty Advisor's Name)
*
Your answer
Supervisor's Email Address
*
Your answer
Supervisor's Phone Number (Optional)
Your answer
What are/were the approximate dates of your independent practicum?
*
Your answer
How many hours a week are you working/did you work on average? (Optional)
Your answer
Are you paid? (Optional)
Yes (Salary/Wage)
Stipend
No
Other:
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