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Experiential Learning

SENIOR LEARNING - Experiential Component Form

Note: All fields are required

Name:
ID #:
Cell Phone:
Email Address:
Major:
Semester:
Course Title:
I am an F1 or J1 visa student? Yes No I have have not spoken to the DSO, Margaret Echanique, about this opportunity.

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 Career Development located in the Union.

In preparation for the SLC,

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

I have have not sought additional assistance from the Center for Career Development.

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 in a for profit company or not-for-profit organization
	B. Research Project which may include activities involving independent study, on-campus research or off-campus research
	C. Creative Project which may include a recital, dance performance, gallery exhibit


A. PRACTICUM
Site:
Web Site:
Site Supervisor Name and Title:
Site Supervisor's e-mail:
Site Supervisor's Phone number:
Practicum Project description. Briefly describe the responsibilities of the practicum and any specific projects or activities involved: ( limit to 250 words)

How did you learn of this Site: ( select all that apply) Student Referral Faculty Referral WICS Career Development Center Personal Contact Other (Limit to 100 words):


B. RESEARCH PROJECT
Title:
On-campus Research Supervisor Name and Title:
If off-campus research is conducted, please provide:
Research Supervisor Name and Title:
Research Supervisor's e-mail:
Research Supervisor's Phone number:
Name of Institution:
Location/Address of Institution:

Please provide a brief description of the research you will undertake a part of your project: ( limit to 250 words)


C. PERFORMING ARTS
Title:
Please provide a brief description of the project you will undertake to complete the experiential component. (limit to 250 words)

At the conclusion of my Senior year, I intend to pursue: ( select all that apply) Graduate or Professional education Full-time employment Volunteer opportunities I would like to discuss my post graduation plans with my faculty adviser. I would like to discuss my post graduation plans with a member of the Career Development staff. Other (Limit to 100 words):

Each year, the Center for Career Development, gathers resumes and CVs to provide alumni and prospective employers. If you would like to have your resume shared with alumni and prospective employers, please submit it to the Resume Referral Book in WICS by October 10th.