The University of Chicago School of Social Service Administration

THE UNIVERSITY OF CHICAGOSCHOOL OF SOCIAL SERVICE ADMINISTRATIONField Placement RequestsThe information below will be placed on the School of Social Service Administration’s AgencyDatabase. The Field Office staff and students use this source extensively to learn about youragency and field placement opportunities.To assist us in matching students with placements that fit their learning objectives, we would like abrief description of the educational experience your field placement will provide.Date:Agency Name:Program Name (if applicable):Address:Phone:E-Mail:City, State, Zip:Fax:Website:Person who Coordinates Field Placements:Name:Phone:Fax:E-Mail:Address (if different from above):Please list any additional field instructors: (Each field instructor is required to complete apersonal data form).