PSYCHOLOGY FIELDWORK SITE INFORMATION FORM
Please
complete this form and send to Janine.Ogden, M.S.,
L.M.H.C., Undergraduate Psychology Fieldwork Coordinator by one of the methods
below.
1. fax: (845) 575-3965
2. email:
Janine.Ogden@Marist.edu
3. mail:
PSYCHOLOGY
FIELDWORK SITE INFORMATION
Please
add our updated fieldwork information below to the webpage listing
of fieldwork sites.
Name
of Fieldwork site: _________________________________________________________
Name
of Agency Contact person: __________________________________________________
Phone
for contact person: ________________________________________________________
Email
address for contact person: __________________________________________________
Fieldwork
address: _____________________________________________________________
____________________________________________________________________________
Fieldwork
webpage: ____________________________________________________________
Population
(e.g., children, adults, etc.): _____________________________________________
Type
of sites (e.g., residential, outpatient, etc.): _______________________________________
_____________________________________________________________________________
Description
of fieldwork duties (e.g., research, counseling, BA-level testing, teaching,
etc.):
______________________________________________________________________________
______________________________________________________________________________
Driving
Time from Marist: _______________________________________________________
Note:
Fieldworkers may work either 9-, 18-, 27-, or
36-hour/week schedules.
Do
you have a scheduling preference or requirement regarding scheduling?
If
so, state your preference:
______________________________________________________
Agency
Representative’s Signature and Date: ________________________________________