WILMINGTON UNIVERSITY AMS PROGRAM ION FORM GUIDED PRACTICUM/CAPSTONE PROJECT COMP! PART A: (To be completed by student) sadent Name: BRANLY bvwagyo we 2d - deess: 2524 SACGQUCWWC H-_City State ANG, PA 2 HW 1dE10 Aion 2578 BCA aren ria PO, PA 7p TEEN : Cell Phone #:_ZIT_§ ZT OKE Sroat_parmyage © gras cow Home Phone Completion Date PART B: (To be completed by Site Supervisor) Giuided Practicum Option x SGulded Practice above-named student has competed _'2°>__ ttl cock hors of Practicum expenence ander my supervision at the site idemtitied below. This i acewateas of 4-2 $1 7 (Date. ‘Capstone Project Option reer to certify tha the above-named student has completed the capstone submited to the agency project and thatthe work product has been Name of Agency: ciysine Join har tp 19601 Phone Number___302-$23 -3757 _ pae__4-2817 Address: PART C: (To be completed by the Faculty Field Instructor) “This isto certify hat [have verified that the student successfully completed the following: 123 Torat Clock Hours of Practicum Experience Capstone Project Date: Faculty Field Instructor Signature: (The accuracy ofthis information has been verified through student contact, Site Supervisor contact, and an ‘examination of the student's weekly log.) PART D: Capstone Project Requirement (To be completed by student and AHS Program Chair) ‘hiss to cenify thatthe student's Capstone Project work product has been submited to the host agency. A copy of the ‘Capstone Projest has been submitted to the AHS Program. os inthe student's permanent academic file rude Signatur: pu 4126117 ‘AHS Program Chair Signature: Dat