African American Affairs Practicum Application Form

African American Affairs Practicum Application Form

PAS 41992

Department of Pan-African Studies

Kent State University

Students wishing to enroll in PAS 41992 should develop a project (1) that is based on their major, (2) that is relevant to the lives and affairs of African people in general or Africans born in the Americas in particular, and (3) that will provide them with a well thought out and rigorous learning experience. DPAS encourages students to conduct field study and research by developing research projects, which employ the skills obtained through their respective major fields of study or academic interest.

Before submitting this application form, you must discuss your plans, learning goals and objectives with the faculty member who has agreed to supervise your practicum semester. By the beginning of the study semester eligible students will 1) have reached junior standing, 20 be in good academic standing and 3) have completed a substantial portion of the major in PAS. Please submit this form to the Undergraduate Student Advisor in the Department of PAS.

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Student Name: Click or tap here to enter text.Phone: Click or tap here to enter text.Email: Click or tap here to enter text.

Number of Hours requested (01-05): Click or tap here to enter text.

Major: Click or tap here to enter text.Minor: Click or tap here to enter text.

Major GPA: Click or tap here to enter text.

Anticipated Graduation Date: Click or tap here to enter text.

On a separate page, briefly, but specifically, describe prior and/or current experience in the area you plan to do work in. Also, include the relationship of the Practicum to your academic and career program.

On a separate sheet, list your practicum learning goals and objectives. You should develop these educational and/or professional objectives that a practicum will help you meet by communicating first with your advisor and then, if relevant, with your organization practicum supervisor.

I agree to supervise this student in the work described above and to supply any information as specified to aid the instructor’s final evaluation for the student.

Sponsoring Organization: Click or tap here to enter text.Phone: Click or tap here to enter text.

Address: Click or tap here to enter text.

Supervisor: Click or tap here to enter text.Phone: Click or tap here to enter text.Email: Click or tap here to enter text.

Supervisor’s Position: Click or tap here to enter text.

I approve this student’s placement and agree to monitor, evaluate and assign the final grade certifying the credit for this Practicum.

Departmental Supervisor’s Signature: Click or tap here to enter text.Date: Click or tap here to enter text.

I agree to fulfill the assignment as described above and understand what is required of me, the criteria that will be used for evaluation, and the nature of the grading.

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Student (print)DateSignature of Student

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Undergraduate Faculty Advisor/ChairSignatureDate

FORMS WILL NOT BE ACCEPTED AFTER THE FIRST WEEK OF CLASSES