Curricular Practical Training Faculty Request

To be filled out by the faculty member supervising student.

Student Name * Required
First Last
Hours per week student is expected to participate in CPT * Required
Position Title and Basic Description of duties this position will participate in: * Required
Training Course Name and Number * Required

Please list the prefix of the course name and number that the student is registered in that pertains to this training.
CPT Supervisor Name * Required
First Last
Person who oversees this type of training for the student's program at UAMS.
CPT Supervisor Email Address * Required

ADMIN. WEST BUILDING, 300 HOOPER DRIVE, 2ND FLOOR, 1.213