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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.

i.e. housing, senior services, volunteer services, business development, etc.


Contact Information
If applicable
Address
Agency Administrator/Director
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 check 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 Brill, Margaret P last modified Jan 31, 2014 08:56 AM