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Agency Information

Field Placement Agency Information

Complete and submit this online form.  Your application will be reviewed by the Human Services Leadership (HSL) Office of Field Placement. Approved sites will be eligible for student field placement.

If your agency is applying for student interns for more than one program area of your agency, please complete this form for each of the programs you wish to have interns placed.

Please select all that apply.
If you indicated "other" above, please provide a brief description below.

Contact Information
If applicable
Agency Administrator/Director/Main Contact
Agency Description

Please describe the mission of your agency in a sentence or two in the box below.
Who are the populations your agency service?
Briefly describe the services you offer in the box below.
If you would like to upload a brochure or flyer for additional information, do so here.
Field Placement Supervisor
Please note degrees, training and experience

Internship Information
What are the proposed assignments, learning and leadership mentoring opportunities?
Please select all that apply.
Please select all that apply
Must be entered numerically
Please select all that apply
Please select the UW Campus you are interested in partnering with.

This Field Placement application is for the HSL Collaborative Program only.

If you are interested in being considered a placement site for our other HSL programs, please indicate below. We'll see that you receive more information.

** Traditional placement agencies need to be with the general Fox Valley Area.
by brillm — last modified Jan 31, 2014 08:56 AM