Teaching Apprenticeship Authorization
Department of Sociology, Anthropology and Social Work
USA Programs in Gerontology
(RESTRICTED COURSE)
Student’s Name ______________________________________________________Student # J00________________
Student’s E-mail Address_______________________ _______________________Student’s Phone______________
Student’s Major’s __________________________________ ______________Semester _______________________
Subject & Course # ________________________ Section (s) #____________________ CRN(s)#_______________
Credit Hours: Undergraduate __________________ Graduate _______
Professor _________________________________________
Assignments and/or Description or Activities ________________________________________________________
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Other Requirements (Note: These must be specified if for graduate credit.)_________________________________
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I request permission to take the course(s) specified above. I understand that it is my responsibility to consult promptly
and frequently with my faculty director and to insure all necessary work is completed on time.
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Date
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Student’s Signature
I agree to direct this student’s work and assign an appropriate grade at the conclusion of the course.
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Date
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Faculty Member’s Signature
Approved by: _______________________________________________________
Department Chair
Rev. 7/28/10
Date ____________________