WILMINGTON UNIVERSITY AHS PROGRAM GUIDED PRACTICUM/CAPSTONE PROJECT COMPLETION FORM PART A: (To be completed by student) suaentwame: Kathleen eaine Vacheyos Ladi Adiress: DUS Hembiywray De ciyisime abcess) YE zi 12107 Home Phones: 3029 39-lo Tb cen phone #: 502-M-G19Y emai on paces Completion Date: _S'Jo21 fi? PART B: (To be completed by Site Supervisor) Guided Practicum Option | This isto certify thatthe above-named student has completed total clock hours of Practicum experience under my supervision at the site identified below. This is accurae as of 2NS\\NT (Date) ‘This i to certify that the above-named student has completed the capstone project and thatthe work produet has been submitted to the agency Name of Agency: Weloumse “Yedwsicol Comryih i. aeeeeces ie Set CMadeares RA ciysiate dupe We zips \OTINR ame of Ste Supervisor. SESE Prove Numer Bo AES BONY site Supervisor sine SN oo end __ pe AAT PART C: (To be completed by the Faculty Field Instructor) This is to certify that | have verified that the student successfully completed the Fallowing: Total Clock Hours of Practicum Experience z Capstone Project Faculty Field Instructor Signature Date (The accuracy of this information has been verified through student contact, Site Supervisor contact, and an ‘examination of the student's weekly tog.) PART D: Capstone Project Requirement (To be completed by student and AHS Program Chair) This is to certify that the student’s Capstone Project work product has been submitted to the host agency. A copy of the Capstone Project has been submitted to the AHS Program Chair for inclusion in the student's permanent academic fle Student Signature: __ Date: AHS Program Chair Signature: __ Date