Field Study Course Enrollment Intent Form

Prior to completing this form students must have accepted a placement with a site from the field study catalog. Students can not change their field placement site after the Course Enrollment Form deadline.

INSTRUCTIONS: Use this form for submitting the information necessary for your field study placement and enrollment in Field Study (SocEcol 195). This form will be sent to the field study office, the supervisor you list on the form and and your faculty sponsor. Complete each portion accurately and completely. Incomplete forms will not be approved.

Field study is restricted to Social Ecology juniors and seniors in good academic standing; with a minimum overall GPA of 2.0. Pre-requisite course is: SE 10 and Lower Division Writing if trying to take 195W.

DEADLINE DATES

Aug 24, 2018	Request for space available* - Fall 2018 (Sep 24-Dec 7) If space is still available in field study courses SocEcol 195 or 195W forms received prior to this deadline will be assessed on a first come first serve basis. Notifcations will be sent via e-mail within 5 business days after the deadline.
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 up to two weeks after the deadline as a 'space available request'. These submissions are reviewed in the order received if there is space in the program after students who have met the deadlines have enrolled. Students submitting 'space available reqeusts' can expect a response approximately 4 weeks after original quarterly deadline. Students submitting 'space available requests' 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 *

Email address *

Phone number *

Your major *

Second major (for double majors)

Quarter/Year of proposed field study *

Space Available Fall 2018 (Sep 24-Dec 7)

Winter 2019 (Jan 2-March15)

Spring 2019 (March 26-June 7)

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

Prior to completing this form students must have accepted a placement with a site from the field study catalog. Students can not change their field placement site after the Course Enrollment Form deadline.

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