SLC form

Name*

FirstLast

Id #*

Cell Phone*

Email*

Major*

Course Number*

My Senior Learning Community RFT professor is:*

Semester*

Spring 2013
Fall 2013

I am an F1 or J1 visa student*

Yes
No

In consultation with your RFT faculty member, select an appropriate experiential component for your major. Your professor will assist you in identifying sites or topics for your Senior Learning Community RFT. Additional resources to identify possible sites are available at Wagner College in the Center for Academic and Career Engagement located in the Union.

In preparation for my practicum/ internship:*

I have consulted with my RFT faculty member regarding the experiential component of the SLC
I have not consulted with my RFT faculty member regarding the experiential component of the SLC

In preparation for the SLC *

I have sought additional assistance from the Center for Career and Academic Engagement
I have not sought additional assistance from the Center for Career and Academic Engagement

Please provide the following information for the experiential component of your SLC RFT: I am required to complete a:*

A. 100 hour ( minimum) Practicum which may include activities such as student teaching, clinical rotations, working for a profit company or non-profit organization
B. Research project which may include activities involving indpendent study, on-campus research or off-campus research.
C. Creative project which may include a recital, dance performance, gallery exhibit
D. Blended project
E. Thesis paper

Choose all that apply

Internship company name*

Company address*

Department/ Division *

Site address (if different from company address)

Site supervisors name/ title*

Site supervisors phone number*

Site supervisors e-mail address*

Site supervisors fax number

Company website

Brief description of practicum*

Would you recommend this practicum to future wagner students*

Yes
No

Research project title*

Supervisor *

Location*

Short description *

Creative project title*

Supervisor*

Brief description *

Blended Project*

Supervisor*

Brief description of activities in blended project*

Approved thesis title*

Thesis professor*

Final thesis abstract*

At the conclusion of my Senior Year, I intend to pursue:*

Graduate or Professional education
Full-time employment
Volunteer opportunities
I would like to discuss my post graduate plans with a member of the Career and Academic Engagement
Other (Limit to 100 words)

Choose all that apply

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SLC Experiential Component Form