HDSR Field Study Plan

This form must be completed and turned into the Internship Coordinator by the end of the registration period the semester prior to the start of your Field Study.


Part I
What is your name?
Graduation date?
Today's date?
Home address:
E-mail address
Cell phone number
EC drawer #
Semester(s) for field study
Year
Credits (0-6)


Part II A
Since many of the field placements connected with off-campus study programs are unknown, please select the intended program and have the plan signed by the study tour advisor. Once the field placement is known, complete parts IIB and III.

Off-campus program

Northern Ireland Program
England Program Philadelphia Center Program
Indianapolis Peace House SICE Japan Program
New York Arts  
Describe your desired field study placement (type of work/organization):

Part II B
Agency/organization name
Agency address
Agency phone number
Stated purpose (mission) of the agency
On-Site supervisor's name
Supervisor's title
Student's job description (submit a copy of your position description)
First and last day of work
Daily Schedule

Level of Supervision
How will you communicate with the Internship Coordinator?

Part III

You must submit a resume with your field study plan. Your resume should inculde any volunteer experience you have. Attact to the back of the field study plan.

You must take HDSR 364: field study semester, next fall semeser after completing your field study

Indicate the year you intend to take HDSR 364: