FIELD EDUCATION COVENANT

Information Sheet—Part Two

Fill this information sheet out as completely as possible and return it to the Office of Professional Education with Part One of the Covenant by the last Wednesday of April.

Please type or print clearly all the following information. Please list the best telephone numbers and addresses at which we can contact you.
 

Student: __________________________________________________________________________
Address: __________________________________________________________________________
(for School year  __________________________________________________________________________
of Field Education) __________________________________________________________________________
E-Mail, Fax: __________________________________________________________________________
Telephone: __________________________________________________________________________
Church/Institution: __________________________________________________________________________
Address: __________________________________________________________________________
__________________________________________________________________________
E-Mail, Fax: __________________________________________________________________________
Telephone: __________________________________________________________________________
Supervisor: __________________________________________________________________________
Address: __________________________________________________________________________
__________________________________________________________________________
E-Mail, Fax: __________________________________________________________________________
Telephone: __________________________________________________________________________
Internship Committee
Chairperson: __________________________________________________________________________
Address: __________________________________________________________________________
__________________________________________________________________________
E-Mail, Fax: __________________________________________________________________________
Telephone: __________________________________________________________________________

Please return to: 
Office of Professional Education, Room #311
STH Box #383
Boston University School of Theology
745 Commonwealth Ave.
Boston, MA 02215