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Request to Continue Fieldwork Beyond Program Requirements

Student Name

Meridian Email

Degree Program

Licensure Pathway you are accruing hours toward

Site Name

Current Number of Hours Completed

Have you submitted your Fieldwork Semi-Annual Evaluation and Hour Tracking reflecting the hours above?

See the SAETH KB article for reference.
A
B

Date of last Fieldwork Semi-Annual Evaluation and Hour Tracking submission?

What are your reasons for wanting to continue to accrue fieldwork hours beyond your degree program requirement?

What requirements do you still need to complete to earn your degree?

How do you plan to complete your remaining degree requirements, prioritizing your graduation requirements?

I understand hours may only be accrued while enrolled.

I understand this request is reviewed by the Student Development Committee.

Signature

Signature