PREX Completion Form

Biographical Information

First Name*

Last Name*

W&J Email Address*

Colleague ID Number*

Date of Birth*

Additional Information

Graduation Year*

Organization, Company, or Institution where you completed the PREX*

Name of faculty advisor for your major*
Name the advisor with whom you plan to complete the PREX reflection meeting required to fulfill the Practical Experience graduation requirement.

Email of faculty advisor named above*

Name of second faculty advisor (if applicable)

Email of second faculty advisor (if applicable)

Your PREX mentor is the person on site, or on campus, who supervised your Practical Experience.

Full name of PREX mentor*

Email of PREX mentor*

Select Category of PREX experience:*

Start date of experience.*

End date of experience.*

The five reflection questions below will guide discussion at the required meeting with your faculty advisor, so answer them briefly and thoughtfully. Your answers will be sent to your faculty advisor with whom you plan to have your PREX reflection meeting, with a copy to the Academic Affairs office.

Reflection Question 1: Describe your responsibilities and work environment (up to 75 words).*

Reflection Question 2: Describe the professional skills you developed or practiced during your PREX (up to 75 words).*

Reflection Question 3: Discuss any ethical standards or responsibilities that you put into practice or saw in action during your PREX (up to 75 words).*

Reflection Question 4: Describe how your PREX helped you identify, reinforce, or change your professional goals (up to 75 words).*

Reflection Question 5: Looking ahead, which skills do you still need to develop, or what experiences do you still want to pursue, to move toward your professional goals (up to 75 words)?*

Signature and Acknowledgement

Note to student: When you complete this page, your advisors and PREX mentor will be notified. You will need to schedule a meeting with the faculty advisor you indicated on this form, which will give you an opportunity to reflect on the experience. At the end of that meeting, your advisor will confirm fulfillment of your PREX with the registrar so that it can be entered into your academic record.

I confirm that I will make an appointment with my faculty advisor. I understand that my Practical Experience (PREX) graduation requirement is not fulfilled until my advisor confirms fulfillment.

I agree to the above statement

Electronic Student Signature

Today's Date:*

A copy of your submission will be sent to you, your PREX mentor, faculty advisors, the Center for Professional Pathways, the Academic Affairs Office, and the Coordinator of Science Internships (if applicable). Your answers to the Reflection Questions will be sent only to the faculty advisor with whom you plan to have your PREX reflection meeting.