Student application for REAL 399: Self-Directed Experience

Student application for REAL 399: Self-Directed Experience

Instructions

Use this form to apply for enrolment in REAL 399, Self-Directed Experience. NOTE: The application portal will NOT save drafts of applications. Please consult the REAL 399 Student Guide and ILP Worksheet prior to completing this form:

https://bit.ly/REAL399Guide

https://bit.ly/REALILP

You will need the following materials to complete this application: 1. Name and contact information for a VCU mentor. 2. Name and location of the employer or community organization where the project will take place, including contact information for the site supervisor with whom you will be working. 3. Short title and brief description of the project 4. Detailed learning plan (uploaded as a separate pdf. See https://bit.ly/REALILP for more detailed instructions).

Enrollment in REAL 399 requires sophomore standing and the approval of the REAL office. Students who enroll in REAL 399 should expect to spend 1 to 2 hours per week in reflection and self-assessment activities in addition to the hands-on project.

Date of Application*

Contact information

The following fields ask for information about you and the VCU faculty/staff member who will be serving as your mentor during the project period.

Your last name*

Your first name*

Your VCU email address*

Your VID*

VCU Mentor Agreement

The mentor identified in your application will receive a separate Agreement to Serve form through docusign. Please follow up with them to ensure they have received and signed the form. If you have not identified a mentor, please indicate that you need assistance where prompted below.

Have you identified a VCU mentor?*

Select "yes" if you have secured agreement in writing or verbally from a VCU faculty or staff person to serve as your mentor. They are required to meet with you periodically and assess your progress, provide feedback on your mid-term and final reflections, and submit a final evaluation of your performance in the course.

Select

Who will be serving as your VCU mentor?*

Please provide their first and last name, title, and department.

VCU email address of VCU mentor*

Off-campus learning partner*

Will you be working with an off-campus learning partner (e.g., employer or community organization)?

Select

Off-campus learning partner

This section requires you to provide contact information for the employer or community organization with whom you will be working during the project period. Please include documentation of their agreement to serve as the site for your educational experience in the "supporting documentation" section of the application below.

Staying safe in off-campus experiences

If you are participating in an off-campus, non-clinical activity this semester (such as internships, field placements, or co-ops) please complete this Student Health and Safety Protocols and Acknowledgement form: https://tinyurl.com/VCUREALhealthandsafety In addition, please provide a copy of the Health and Safety Guidelines for Community Partners to the supervisor at your off-campus learning site: https://docs.google.com/document/d/1MK_m8fSCxnBUPkzoX7pgWPGTf6TVfBnyWYbKTbCeTHQ/preview

Name of community/employer supervisor*

Who will be supervising and directing your experience at the off-campus partner/employer site?

Community organization/employer*

Provide the name of the organization or employer with whom you will be working.

Off-campus learning partner: email address*

Provide the best email address for contacting the person who will serve as your supervisor at the community/employer site.

Off-campus learning partner: address*

Provide the physical address and mailing address (if different) where you will be reporting for your REAL 399 experience.

Off-campus learning partner: phone number

Provide the phone number for the off-campus supervisor

General Activity Information

Project title*

Short descriptive title (30 characters max) that communicates the kind of experience your are proposing. Use a simple formula: title of your role + name of employer (for example, "Digital Media Intern: VCU REAL")

Approximate start date of project*

Projected end date of project*

Credit hours for which you are enrolling*

REAL 399 may be taken for variable credit, which means you may choose to take it zero credits, or for up to 3-credits.

You must choose a credit option at the time of application, and should consult with your academic advisor or the REAL office to discuss your options.

Please note: a course taken for zero credits will not be counted into your enrollment or time status and therefore will have no bearing on enrollment verification, financial aid, loan deferment, etc. However, grades of F--even for zero-credit courses--do get included in the calculation of the GPA, and could thus impact your financial aid eligibility. Visit https://provost.vcu.edu/academics/passfailfaq/ for a listing of frequently asked questions about VCU's pass/fail policies.

If the course is taken for academic credit, it will be assessed tuition and fees accordingly.

Select

Supporting documentation: Integrated Learning Plan (ILP) and agreement of off-campus learning site*

Please attach your ILP and any other supporting documentation. You may upload this information as separate files. For a guide and instructions on writing your ILP, see Fall 2021 Guide <https://tinyurl.com/REAL399Fall2021Guide> and ILP Template <https://docs.google.com/document/d/1PcwDIUprP-jIt7-k-bbueNtmK_9chQVeHu81158QLjs/view>

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