Name: _________________________________________   UIN #: ____________________

Address: ______________________________________________________________

______________________________________________________________________

Phone (Home): ________________________      (Work): __________________

Pager/Cell: _______________________________     Email address: ________________________

Overall GPA: ________________                        CRJ GPA: _________________________

Number of hours completed: _____________       Expected graduation date: _______________

CRJ COURSES TAKEN OR CURRENTLY ENROLLED
 

Course	Grade	UIC	Transfer	Elective	Grade	UIC	Transfer
101
200
210
220
240
345, 350,  355
261
262

 

Career Goals: ____________________________________________________________

________________________________________________________________________
 
 

For what semester are you wanting to intern: Semester__________                Year__________

Agencies in which you are interested in interning with: ________________________________

______________________________________________________________________
 
 

Completed and Approved Resume:      Yes          No

Undergraduate Advisor Signature: _________________________      Date:_________________