Fieldwork Application

Application

Welcome to the Department of Health & Human Performance's application for HE 471-4: Field Work in Health Education.

Field Work is a program requirement for Community Health Education (CHE), Gerontological Studies & Services (GSS), and Health Promotion Management (HPM). At the time of application, students must have successfully completed HE 201, HE 223 & HE 234, and HE 331. Students enrolled in HE 331 can apply for Field Work in the same semester. Final approval will dependent upon successful complete of HE 331.

In completing this application, please be sure to answer all questions and provide all materials. Incomplete applications will not be considered.

Applicant Information

First Name

Last Name

CUNY EMPLID if a CUNY student

Email Address Please use your CUNY email address (if you have one)

Phone Number

Semester For what semester would you prefer to be accepted for fieldwork?

Transcript Please attach a current unofficial transcript

Fieldwork Pre-requisites Which of the following fieldwork pre-requisites have you completed/are currently completing?

HE 201 HE 223 HE 224 HE 331

Fieldwork Agency Title

Fieldwork Agency Address

Fieldwork Agency Website

Fieldwork Agency Telephone Number

Fieldwork Supervisor Name

Fieldwork Supervisor Email

Signature

Signature (please check to agree)

I agree, to the best of my knowledge, all of the information I am submitting is correct and true.

Department of Health and Human Performance

Fieldwork Application

Department of
Health and Human Performance