Constructive Action Information Page

Dr. A. Weiner - Metropolitan College of NY Course Web Sites - Spring 2006

Constructive Action Information Page

This form is only to be completed by students
in Dr. Weiner's Constructive Action Seminar.

Name (Last, First)
Name of Agency for CA
Agency Address (Number, Street, City, State, Zip)
Your Phone at the Agency (with area code and ext.)
When did you start your field placement?
Are you an employee?
How long have worked there?
How many hours do you work weekly?
What is your job title?
Briefly describe your job.
Briefly describe your field assignment(s).
Briefly describe potential CA projects.
Name of Supervisor (Last, First)
Supervisor's Phone # (with area code and ext.)
Supervisor's Email
Best Day and Time to Reach Supervisor
Anything else I need to know?

Spring 2006