Field Confirmation Form

Please don't use this field.

Student Information

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone (Home):
Phone (Cell):
Email (RIC Account):
Field Level:

Agency Information

Agency Name:
Agency Address:
City:
State:
Zip Code:
Phone (Home):
Person(s) with whom you interviewed:
Person who will be your supervisor (MSW):
E-mail address of supervisor:
Person who will be your secondary supervisor (if appropriate):
E-mail address of secondary supervisor:

The Office of Field Education will confirm students' placements in writing to the field instructor. Students are responsible for returning the Field Confirmation form to the Office of Field Education after the interview process is complete. The Field Confirmation must contain all requested contact information. Students' hours in the field may not begin until all paperwork is returned, and any hours performed in the field will not be counted until the placement is confirmed.

Page last updated: May. 16, 2013