| Last Name |
|
| First Name |
|
| Email |
|
| Classification |
|
| Major |
|
| Minor |
|
| Current Street
Address |
|
| City |
|
| State |
|
| Zip Code |
|
| Current Telephone (including
area code) |
|
| Permanent Street
Address |
|
| City |
|
| State |
|
| Zip Code |
|
| Permanent Phone (including
area code) |
|
| Specify
career field/occupation in which you are
interested in shadowing: |
|
| Dates
available for shadowing: |
| From: |
, |
| To: |
, |
| Goals
for shadowing: |
| Write at
least three goals. Having goals will help you
focus on what it is you want to learn during
shadowing. (see
sample goals)
|
| This
section on work experience, classes, and
activities provides your sponsor with some
information about your background. Telling
your sponsor a little about yourself may help
break the ice when you first arrive, and also
may help him or her understand where you are
coming from and therefore, provide a more
relevant shadowing experience for you. |
Work
Experience:
Does not have to be related to shadowing
field, but any work that you have done in the
past.
|
Classes:
Should be relevant to shadowing field.
|
Activities,
Organizations, Memberships:
Whatever you would like your sponsor to know
about you.
|
| Please
read this agreement before submitting.
Student Responsibility Agreement
I have read all of the Converse CareerView literature. I understand that I am responsible for researching my sponsor’s career field and organization and for making a list of goals to prepare myself for shadowing. I also understand that I am responsible for notifying my sponsor and the Office of Career Services of any changes in my schedule in the event I am unable to shadow, and for returning the Student Evaluation to Career Services after shadowing. In addition, by
submitting this form, I agree to assure the confidentiality of information I receive from others or obtain from my own observation regarding patients, business plans, private records, and other non-public information. |
