DEPARTMENT OF ENVIRONMENTAL STUDIES UNIVERSITY OF NORTH CAROLINA WILMINGTON
DEPARTMENT OF ENVIRONMENTAL STUDIES
UNIVERSITY OF NORTH CAROLINA WILMINGTON
601 S. College Road, Wilmington, NC 28403-5949
Phone: 910-962-2423 Email: snidera@uncw.edu
PLEASE READ THE EXPLORATIONS PROGRAM REQUIREMENTS BEFORE SUBMITTING: http://www.uncw.edu/evs/includes/ExplorationsBeyondClassroom.html
Explorations Beyond the Classroom
Suggested Host Organization Form
***All questions must be answered***
Student Name: _____________________________________ _____________________________________ ______________
Last First Middle Initial
Student ID# ________________ Student Email ________________ @uncw.edu Student Phone ____________________
Year in School:
Select
Major:
No
Concentration:
Select
Grad Program (if applicable)
N/A
0
(ASL is restricted to 1 credit hour)
* each credit hour requires a minimum of 40 hours logged work time *
Name of Suggested Host Organization: _______________________________________________
Type of Organization: ____________________________________________
Organization Address : ____________________________________________________________________________________
____________________________________________________________________________________
Contact at Suggested Organization:
Name : ________________________________ Position : __________________________________
Email : ________________________________ Telephone : ________________________________
Described the proposed work with the Suggested Organization:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Explain how a placement at the Suggested Organization will advance your degree in EVS:
2
____________________________________________________________________________________________________________
____________________________________
____________________________________________________________________________________________________________
________________________________________________________________________
Explain how a placement at the Suggested Organization will advance your career after graduation:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Are you presently employed at the Suggested Organization?
Select
If so, how many hours do you work there per week?
_____
Will this placement be available to other students in the future?
No
If so, during which sessions will it be available?
Fall
Spring
Summer
How many positions will be available per session?
Fall
(if none, write N/A)
_____
Spring _____
Summer _____
What Special Skills are required for this position?: (List all field skills, computer skills, lab skills, etc.):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
**Please note that if the placement is approved, you will have to submit a separate EVS Uniform Application to Dr. Snider before you can be registered for the associated class (ASL or Practicum)***
PLEASE READ THE FOLLOWING AND INDICATE YOUR AGREEMENT BELOW:
• I have answered all the above questions truthfully and as completely as possible.
• I understand that this application does not guarantee acceptance of the Suggested Organization by the EVS Department as an acceptable host for Explorations Beyond the Classroom.
• I understand that participation in the Explorations Beyond the Classroom program (ASL and Practicum) requires a separate application.
Type Your Name: ____________________________________________ Date: ______________________________
