Dr. A. Weiner - Metropolitan College of NY - Fall 2009

Field Instructor Information

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Please complete this Field Instructor Form.

You have received a link to this page from Dr. Adele Weiner because you are the field instructor for a MCNY student's field experience.

If you have any questions, please contact Dr. Weiner at
aweiner@mcny.edu (preferred) or 212-343-1234 x. 2221.

After you complete the form, click the submit button at the bottom of the page and the form will be sent to Dr. Weiner.


Field Instructor's Name
Job Title
Name of Student
Briefly describe your expectations for the student field placement (days, assignments, services, client population, etc.):
Name of Agency
Briefly describe the Agency:
Agency Address
Field Instructor's Agency Telephone Number
Field Instructor's Agency Email Address
Field Instructor's Highest Degree
How many years have you been a field instructor?
How many student interns have you supervised?
Do you have specialized training in field instruction?
If yes, please describe:
Is there anything else that the faculty needs to know about the student's field placement in your agency?