REG-PS.
501
UNIVERSIDAD*CATÓLICA*DE*HONDURAS*
“NUESTRA*SEÑORA*REINA*DE*LA*PAZ”*
SOLICITUD*DE**
PRÁCTICA*PROFESIONAL*SUPERVISADA*Y**
*CONSTANCIA*DE*SUPERVISIÓN**
DE*PRÁCTICA*PROFESIONAL*SUPERVISADA,*PRACTICA*PUBLICA*O*SERVICIO*SOCIAL*OBLIGATORIO*
*
FECHA(DE(SOLICITUD:(___________________________________________________________________________________________((
DERECHO
NÚMERO(DE(CUENTA:_____________________________________________________((CARRERA_____________________________(
NOMBRE(DEL(ALUMNO:___________________________________________________________________________________________(
DIRECCIÓN:_____________________________________________________________________________________________________(
TELÉFONO:__________________________________________________________CORREO(ELECTRÓNICO:_____________________(
NOMBRE(DE(LA(EMPRESA(O(INSTITUCIÓN:__________________________________________________________________________(
DIRECCIÓN:_____________________________________________________________________________________________________(
TELÉFONO:_________________________________________________________________(FAX:(_______________________________(
CORREO(ELECTRÓNICO:_________________________________________________________________________________________(
NOMBRE(DE(LA(PERSONA(A(QUIEN(SE(DIRIGE(SOLICITUD(EN(LA(EMPRESA(SELECCIONADA(
_________________________________________________________________________________________________________________(
CARGO:(______________________________________________________________________________________________________(
UNIDAD(O(DEPARTAMENTO:(_____________________________________________________________________________________(
(
Por( este( medio,( yo( __________________________________________,( con( tarjeta( de( identidad( No.(
_________________________,( vecino(a)( de( este( domicilio,( una( vez( presentada( la( documentación( requerida,(
habiendo( aprobado( todas( las( clases( de( mi( pensum( académico,( comparezco( ante( Ustedes( solicitando( se( me(
autorice(la(realización(de(mi(Práctica(o(Servicio(Social,(en(el(lugar(que(estimen(conveniente.(Asimismo,(exonero(
a(la(Universidad(Católica(de(Honduras(“Nuestra(Señora(Reina(de(la(Paz”(por(cualquier(problema(de(mala(praxis(
durante(mi(actividad.((
(
______________________________(
FIRMA(DEL(SOLICITANTE(
(
SUPERVISIÓN*
( (
NOMBRE(DEL(SUPERVISOR_________________________________________________(
(
INFORME:(
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________(
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FIRMA(DEL(SUPERVISOR:(__________________________________________(
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____________________________________(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((____________________________________(
UNIDAD*ACADÉMICA* * * * * * * EMPRESA*
FIRMA*Y*SELLO* * * * * * * * FIRMA*Y*SELLO
Versión(5,(Aprobado(14(de(Junio(2011( ( ((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((