International & Cultural Requirement Post-Form
Whitacre College of Engineering
First Name: ____________________
Last Name:_____________________
R#: __________________________
Department: ____________________
I have fulfilled my international requirement through other forms of educational and cultural programs, such
as: service-learning, sponsored programs, CO-OP and/or research abroad. My program was approved by an
advisor at the International Engineering Program’s office. With this form, I have also provided my
documentations from my country leader and/or supervisor. In additional, I will provide a letter that entails the
duties of my activities and duration of my program with a signature from my international supervisor.
Title of Activity: ____________________________________________
Country Visited: ____________________________________________
Duration of Program: ________________________________________
Date of Submittal: ___________________________________________
Attach the documentation from country leader and/or supervisor of job responsibilities, activities, duration,
etc.
Reference/Supervisor/Coordinator Information
Name: _____________________________
Phone: _________________________
Email: ______________________________
Completion of Global Scholar Certificate: ___________ YES
Signature of Student: __________________
___________NO
Date: ____________________
******************************************************************************
FOR OFFICE USE ONLY
_________ Approved
________ Not Approved
_____________________________
Director, International Programs
Date: ____________________
____________________________________
Associate Dean for Undergraduate Studies