Field Placement Confirmation Form

Spring Field Study 2021:

***Please only submit a Fieldwork Placement Confirmation form if you have confirmed and secure a placement for the Spring 2021 quarter AND you have been authorized to enroll in a field study course.

Submit your FIeldwork Placement Confirmation HERE (Link not yet available)

DO NOT SUBMIT A COURSE ENROLLMENT FORM - THIS FORM IS TEMPORARILY DEACTIVATED

DEADLINE DATES	Spring 2021 Deadlines
February 5	Spring Field Study Request for Enrollment Form Due
March 12	Spring Fieldwork Confirmation Form Due (link will be posted on this page after February 12, when all Spring Field Study enrollment authorizations have been completed)

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 *

Not available at this time

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 as demand exceeds seats available. Students will be able to enroll during their enrollment window and once 195W is full, students will need to enroll in 195. There are other classes that can fulfill upper division writing. A grade of a C or better in 4 units or more of SocEcol 195W, Field Study Writing Seminar, will fulfill field study and the upper division writing general education requirement.

Traditional or Writing *

Traditional Field Study - SocEcol 195

Field Study Writing Seminar - SocEcol 195W

Please indicate if you would prefer to take 195 (fulfills the field study requirement) or the 195W ( fulfills both field study and upper division writing if you earn a grade of C or better). 195W demand is high so this is only a request, there is no guarantee of placement in 195W. Click here for more information on the difference between 195 and 195W.

Placement information

Placement site number *

Available in the SE Field Study Catalog

Placement Site Name *

Placement Site 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 student tasks *

In your own words provide a description of the work you will be doing at your site such as things discussed in your interview. If you are not clear on what you will be doing you could contact your supervisor to gain clarification. "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? 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 Placement Confirmation Form

Spring Field Study 2021:

DO NOT SUBMIT A COURSE ENROLLMENT FORM - THIS FORM IS TEMPORARILY DEACTIVATED

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