Field Work Petition for 195ACourse
Women’s Studies Department
Name
Student ID
*not your SSN
Address
Phone Number
Email
Class Level
Junior
Senior
Graduate Student
Semester
Faculty Sponsor
Number of Units
(1-3 units possible)
Description of Work and Requirements
Site Supervisor and Contact Information (if applicable)
Student Signature
Date
Sponsor Signature
Date
Department Chair Signature
Date