2021-22 Student Interview Choice Form

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MSW Dept. of Social Welfare Students choose 2 agencies they would like to interview for their 2nd year placements.
Students are REQUIRED to meet with the Agency Field Liaison BEFORE submitting this form.

Deadline: Thursday, February 25, 2021

Submit this form by Thursday, February 25, 2021

Student Last Name *

Student First Name *

Student's Email *

Field Liaison *

Summer Placement *

Preferred agencies to interview with:

Agency #1 (Name as it is listed on IPT) *

Agency Liaison of Agency #1 that I have MET with: *

Agency #2 (Name as it is listed on IPT) *

Agency Liaison of Agency #2 that I have MET with: *

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