Out-of-State/Area Fieldwork Request
By submitting this request, you are prioritizing location for your Level II fieldwork experience. Please submit a request form and communicate with the Academic Fieldwork Coordinators in the practice areas in which you are eligible for Level II fieldwork.
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First Name *
Last Name *
Email *
Graduating Class
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Cohort
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Indicate Session and Year you are requesting
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Spring 2021 will be my:
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Summer 2021 will be my:
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Fall 2021 will be my:
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Desired geographical location(s) (Be specific, i.e., neighborhoods, town or address if available, etc.)
Transportation
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Rank eligible practice areas (1=top preference)
1
2
3
Pedatrics
Mental Health
Adult Physical Rehabilitation
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Please list, in order of preference, specific fieldwork sites you are interested in (available in EXXAT).
Please list any additional fieldwork sites you are interested in that ARE NOT currently available in EXXAT, including reason that you are interested in these sites, other than location. Include facility name, facility website, and any available contact information.
This request sets in motion a process that includes outreach to existing and/or new fieldwork sites and potential negotiation of a student affiliation agreement, which may take several months to complete. The USC OT Fieldwork Team cannot guarantee that this request will be fulfilled; however we will make every effort to secure a placement. It is the responsibility of the student to work with the Academic Fieldwork Coordinator(s) to identify possible fieldwork sites in the desired location and potential practice areas.Student’s Statement of Commitment: By clicking 'yes' below, I agree to accept the fieldwork placement that the USC OT Fieldwork Team arranges for me, a process initiated by this request. In the event that I decline the placement that is secured for me, I understand that my new request will be considered only after all students receive an initial placement. *
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