Department of Kinesiology and Health Education
Request to take Fieldwork or Independent Study
UNDERGRADUATE LEVEL
BE SURE ALL ITEMS ARE COMPLETED BEFORE SUBMITTING FOR APPROVAL
Name:
UT EID:
Address:
E-mail:
Phone:
UNIQUE NUMBER:
Semester:
KIN 127L
KIN 227L
KIN 327L
KIN 178
KIN 278
KIN 378
KIN 379H
KIN 678
, 20
Faculty Supervisor:
Grading Scale (circle one): Pass/Fail
Letter Grade
Major:
Applied Movement Science
Health Promotion
EC–6, Special Education, Youth and Community Studies
Athletic Training
Physical Culture and Sports
Exercise Science
Sport Management
Other (specify):
a
a
Grade point average:
Overall GPA
Fieldwork/clinical work will be used as:
Elective credit within major
Elective credit outside major
To fulfill degree requirement
Other
Proposed Fieldwork:
Research Assistant
Teaching Assistant
Coaching Assistant
Student Trainer
Exercise Technician
Other
Major GPA
Agency or Institution:
Public School
Commercial Institution
Community Agency
University Class
Exercise Leader
Other
Brief Description of Field work or Independent Study:
Number of hours to be worked per week:
SIGNATURES
STUDENT:
FACULTY SUPERVISOR:
SITE SUPERVISOR:
CAMPUS ADDRESS:
PHONE:
DEPARTMENT CHAIR:
APPROVED
DATE
THIS FORM MUST BE SUBMITTED TO BEL 1005 BEFORE YOU WILL BE ALLOWED TO ENROLL IN CLASS
YOU MUST ADD THE CLASS AFTER BEING CLEARED