Child Study Center Request for Field Experience

UCA faculty...please complete this form as early as possible to ensure that we can accommodate your field experience.

Faculty/Staff Name * First Last
Faculty/Staff Email *
Department *
Name of Course/Class
Start Date of Requested Visit * / MM / DD YYYY
End date of Requested Visit * / MM / DD YYYY
Time of Requested Visit (can list multiple times for a single day or "various" for non scheduled visits). *

Enter a time if an entire class is coming at one time. Enter various if students can choose when they want to come.
Number of UCA students attending *
Number of Children Needed for Experience *

enter "various" if the experience is observation only
What is the objective for your students while at the Child Study Center? *
How can I help to be sure that your objectives are being met? *
Any additional information I need to know (optional)?