Prior Approval Form

This form must be completed and approved by WORK EXPERIENCE INSTRUCTOR, Renee LoPilato, BEFORE ATTENDING THE SEMINAR.

*This FORM is ONLY for Seminars / Workshops / Activities NOT LISTED IN WORK EXPERIENCE HANDBOOK*

You will receive an email from A Work Experience Instructor regarding approval.

Your name:

Your email address: Please enter carefully, correctly, and completely

SID #

The Work Experience office may give credit towards the seminar requirement for attendance at workshops, seminars, in-service training, etc., provided that the following conditions are met.

1. The activity must be over and above work done on the job. Credit will not be approved if you are receiving units for the activity or if the activity is a requirement for another class.

2. The student must submit this form for credit BEFORE attending the workshop, seminar or in-service training.

3. The Work Experience instructor, Renee LoPilato will then approve or disapprove the request and reply to you via email.

4. A typed written 1 page report with the activity description and what you learned must be submitted to the Work Experience Office or may be emailed to Work Experience Instructor Renee LoPilato - rlopilato@santarosa.edu AFTER ATTENDING.

**CREDIT IS NOT GIVEN UNTIL THE REPORT IS RECEIVED AND APPROVED BY THE WORK EXPERIENCE INSTRUCTOR**

In the following space, type the number 1 if you are requesting Prior approval for an On-Campus Seminar or Workshop. Type the number 2 if you are requesting prior approval for an Off-Campus Seminar or Workshop.

Activity Description (date, time(begin and end), topic, location, speakers or presentors)

In the space below, write the number of hours of credit you request. 1 - 6 hours