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:

School of Social Ecology majors
Social Ecology Juniors and Seniors (90+ units)
Students with a minimum overall GPA of 2.0
Students who have received and accepted an offer from a field study site listed in the field study catalog

Course Pre-requisites:

195: SE 10
- All students who meet the course enrollment form deadline and all pre-requisites will be guaranteed a spot in SocEcol 195, Traditional Field Study
195W: SE 10 and Lower 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. 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.

Additional steps are needed for international and continuing education students:

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
May 10, 2019	Summer 10 Week Session (June 24-August 29)
May 24, 2019	Summer 10 Week Session (June 24-August 29) - Space Available Request*
June 21, 2019	Summer Session II 5 Weeks (August 5-September 9)
August 9	Fall 2019 (September 23- December 6)
November 8	Winter 2020 (January 2-March 13)
February 14	Spring 2020 (March 25-June 5)

*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 *

Summer II 5 Week 2019 - Traditional Field Study - SocEcol 195

Fall 2019

Winter 2020

Spring 2020

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 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 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 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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