University of Texas at Arlington
Department of Criminology and Criminal Justice
Internship Practicum Application
Name:
UTA ID Number:
UTA email address:
Telephone number:
Local Address:
Current cumulative GPA:
CRCJ GPA:
Total number of hours completed (by transfer and in residence at UTA) by the end of
this present semester:
Anticipated semester of graduation:
Number of hours for which you will enroll in CRCJ (special permission required for 6
hours):
If working another job, number of hours per week required:
Will you structure your class schedule to be able to devote one day per week to the
internship (not required, but preferable for the best experience)?
YES NO
Number of CRCJ course completed at UTA and all other institutions:
List CRCJ courses, by course number, completed at UTA:
Do you have transportation to the work site?
YES
Do you have medical and automobile insurance?
YES
NO
NO
Do you have any health issues that will need to be taken into consideration? YES
NO
Do you consent to a background investigation if one is required by the internship
agency/organization?
YES
NO
Signature of Applicant:
Date signed:
Submit this application to the CRCJ Internship Practicum Coordinator along
with your resume and a cover letter explaining why you are applying.