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Application for Field Experience Hours & Recreational Therapy Field Experience Hours
Name:
First
Last
Phone:
Email:
University:
Standing:
Freshman
Sophomore
Junior
Senior
Graduate
Total Field Experience Hours Required:
Total Field Experience Hours Completed:
Field Experience Hours Due Date:
MM slash DD slash YYYY
Are you interested in paid opportunities to earn non-C.T.R.S. field experience hours?
Yes
No
Total C.R.T.S Hours Required:
Total C.R.T.S Hours Completed:
C.T.R.S. Hour Due Date:
MM slash DD slash YYYY
Shadowing Locations Desired:
Are you willing to commute?
Yes
No
Do you have the ability to commute independently?
Yes
No
Dates and Times Available:
(Be specific - please list any anticipated interruptions in scheduling [vacations, family commitments, final exams, athletic competitions, etc.])
What population would you like to work with after graduating?
What setting would you like to work in after graduating?
What state would you like to work in after graduating?
Please list any other relevant information:
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