Field Study Course Enrollment Intent Form

INSTRUCTIONS: Once you have received and accepted an offer with an approved field study site from the catalog submit this form.

Complete each portion accurately and completely as incomplete forms will not be approved. This form will be sent to the field study office, the supervisor you list on the form and and your faculty sponsor. Field Study placements can not be changed after the deadline.

Field study is restricted to:

Social Ecology Juniors and Seniors
A minimum overall GPA of 2.0
195 Pre-requisite course is SE 10
195W Pre-requisite's are SE 10 and Lower Division Writing

For information regarding Continuing Education Concurrent Enrollment please click here: Concurrent Enrollment Process

International students need to obtain a CPT through the UCI International Center. Please review process here: Curricular Practical Training Process

DEADLINE DATES	Quarter
November 9, 2018	Winter 2019 (Jan 2 - March 15) Students meeting the deadline and pre-requisites will be able to enroll in SocEcol 195 or 195W via WebReg once they receive an e-mail authorization within 5 business days after the deadline.
February 15, 2019	Spring 2019 (March 26-June 7) Students meeting the deadline and pre-requisites will be able to enroll in SocEcol 195 or 195W via WebReg once they receive an e-mail authorization within 5 business days after the deadline.

Course enrollment forms will be accepted for 2 weeks after the deadline as a 'space available request'. These submissions are reviewed if there is space in the program in the order received. A response can be expected approximately 4 weeks after original deadline. Students MUST inform their sites that they are applying for the waitlist and that they will not know if they have been accepted to the program until approximately 4 weeks after the initial deadline.

UCI ID Number *

Name

First Name *

Middle Name

Last Name *

UCI Email address *

Phone number *

Your major *

Second major (for double majors)

Quarter/Year of proposed field study *

Winter 2019 - Traditional Field Study - SocEcol 195 (Jan 2-March15)

Winter 2019 - Field Study Writing Seminar - SocEcol 195W (Jan 2-March15)

Spring 2019 -Traditional Field Study - SocEcol 195 (March 26-June 7)

Spring 2019 - Field Study Writing Seminar - SocEcol 195W

IMPORTANT NOTE: All students who meet the course enrollment form deadline and all pre-requisites will be guaranteed a spot in SocEcol 195, Traditional Field Study. Enrollment in SocEcol 195W is NOT guaranteed and demand is expected to exceed seats available. Students will be able to enroll during their enrollment window. Once 195W is full, students approved will need to take SocEcol 195. Keep in mind, there are other classes offered that you can take to satisfy upper division writing. A C or better in 4 units or more of SocEcol 195W, Field Study Writing Seminar will fulfill the upper division writing general education requirement.

Placement information

Placement site number *

Available in the SE Field Study Catalog

Placement agency *

Agency phone number *

Agency address

Street *

City *

State *

Zip code *

Supervisor's name *

Supervisor's email address *

Hours per week *

Number of units requested *

Is this a PAID position? *

Yes

I have accepted a placement at the site listed on this form *

Yes

Yes, background check pending

No - STOP! You must have accepted and confirmed a placement to submit your course enrollment form.

Description of agency and duties *

In your own words provide a brief description of your placement agency and the work you will be doing there as discussed in your interview with them or thereafter. If you are not clear on what you will be doing you could contact your supervisor to gain clarification. Do not assume the catalog provides all the information you need. For example "assisting with programs" does not provide enough information to evaluate your duties, however, "creating flyers, calling clients, and staffing events" does.

Academic goals - Research Question - What theory or construct from your classes can you observe or examine at your site? Broad Example: I'd like to examine the group therapy setting and find what specific therapeutic goals are achieved through this approach. *

It can be helpful to your site if you also indicate any personal goals you have for your field study experience.

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Field Study Course Enrollment Intent Form

INSTRUCTIONS: Once you have received and accepted an offer with an approved field study site from the catalog submit this form.

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