Site Registration Form - Erskine Seminary

Student Name*

You should have all the information about your potential field placement site available before your attempt to complete this document. You may NOT start working at any site with an authorization from both the site and you Faculty Supervisor. If you switch placements, or have a placement at more then one location, you must complete this form.

Student Email:*

Student Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am completing this form for (term/year) semester:*

Name of your proposed site:*

Name of your proposed supervisor:

First Last

Email address of your proposed supervisor:*

This is for:

Practicum
Internship