Please complete one form per student user request.

Organization

Name of Organization:

Street Address:


City:
State: Zip:
Fax:
Website:

Project Supervisor

Name:

Title:

Email:

Phone:

Project Overview

In a paragraph, please describe the project:

Desired Student Skills/Knowledge/Area of Expertise

Briefly describe the ideal student candidate:

Desired Student Availability Per Week

Please select how many hours per week you require of the student
Full Time (40 Hours Per Week)Part Time (20 Hours Per Week)

Resources and Requirements

Describe the resources offered to the student (work environment, location, equipment provided) and the student’s required equipment, physical abilities and means of transit to field sites outside of the daily workplace.

Desired Project Results and Community Impact

Outputs: What are the anticipated deliverables/products delivered by the student at the end of placement?

Community Impact: How will this work impact your organization and community?

Educational Results: What do you expect the student to learn from their placement experience?