Personal Information Form - DOC by 1ut45Np

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									                 SSE 4335/5946 Personal Information Form
     ONLY Students officially admitted to an SSE Major may take this Course

Student ID

First Name

Last Name

Mailing Address

City, State, Zip Code

In which section of
town do you live?
Phone Numbers                     H:                                 C:

E-Mail (Required)

School Assignment
(leave blank)
Are you currently a full-                             If so where & what do you teach?
time social studies
teacher?

When did you complete SSE 4333/5331?
(Undergraduate students have a C- or higher and graduates students a B or higher to take the
course)

Semester/Year ___________ Instructor________________________ Grade_____
Are you officially admitted to the SSE program? Check which program
(Nondegree, Graduate Certificate, and students who are not majors may not take the course)

_____Undergraduate                  _____MAT              ______M. Ed

What is your current overall USF GPA __________
(Undergraduate students must be 2.5 and graduates student a 3.0 or higher to take the course)

When do you plan to Intern?

Spring___________            Fall______________

I enroll in this course with the full understanding of the special nature of a clinical experience course and
the course requirements as outlined in at the website and by the course instructor. I hereby grant
permission to have my documents duplicated and made available for review by accrediting bodies and the
State of Florida. By my signature I confirm that I have read the syllabus and understand the special
responsibilities and duties associated with this course.



Signature                                                                 Date

								
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