PREX Intention

Biographical Information

First Name*

Last Name*

W&J Email Address*

Colleague ID Number*

Date of Birth

Additional Information

Graduation Year*

Name of faculty advisor for your major.*
If you have more than one, 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*

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

Full name of PREX mentor*

Position title of PREX mentor*

Email of PREX mentor*

Organization, Company, or Institution

Location of experience*

Country

Street

City

Region

Postal Code

Select Category of PREX experience:*

Start date of experience*

End date of experience*

Title of experience (or brief description)*

Has this PREX experience been pre-approved?*

Yes, this is an internship or other experience I found on Handshake that is labeled "PREX-eligible."

Yes, this experience has been pre-approved for PREX eligibility by Dr. DeBerry, the Coordinator of Science Internships.

Yes, this experience is offered through a course or campus department and is labeled as "PREX-eligible."

No, it has not been pre-approved. I would like to propose this experience for my PREX now.

PREX Proposal

What type of experience are you proposing?*

Internship I found myself or with the help of a department or advisor

Work position or job that fits the PREX requirements

Volunteer position that fits the PREX requirements

Research position I found myself or with the help of an advisor that fits the PREX requirements

Other (please describe)

Other (please describe)

Briefly describe your intended experience or position*

How did you find this experience?*

Confirm this experience involves at least 40 hours of work.*

Yes, it involves at least 40 hours of work

No

You've selected "no," this will not count for the PREX. Please talk to an advisor.

Describe how this experience builds on knowledge and skills gained through a course or a collection of courses. These skills might include critical thinking, problem solving, team work, oral and written communication, ethical reasoning, digital technology, leadership, global and cultural fluency, professionalism, etc.*

Describe your professional responsibilities in this position.*

Describe how you will be mentored when working in this position, such as one or more training sessions, periodic check-ins, direct supervision, etc.*

Enter the Handshake number for this experience.*

Have you applied for funding for this experience?*

Indicate the name of funding source (if applicable)

Have you received this funding?*

Provide the course title or description for this experience.*

Signature and Acknowledgement

Electronic Student Signature

Today's Date:*

A copy of your submission will be sent to your PREX mentor, faculty advisor in your major, Academic Affairs Office, and the Coordinator of Science Internships (if applicable).