Externship Registration Deadline Extension Request
The deadline to register for an externship is the last day of add/drop. Students may request an extension to register for an externship if they are in the process of applying for a position where they may earn externship credit. Please complete this form to request an extension.

NOTICE: Students granted an extension must attend the externship orientation offered the first week of classes, complete requisite Externship Program paperwork and assignments by the dates they become due, and use best efforts to complete the registration process as soon as reasonably possible after the add/drop deadline.

***Students requesting an extension must complete this form by 5:00pm on the last day of add/drop***
Email address *
First Name *
Your answer
Last Name *
Your answer
CWID *
Your answer
Please explain why you will not complete the Externship Checklist by the deadline (last day of add/drop). Your response should be stated in 3-6 complete sentences. *
Your answer
Please provide the approximate date that your paperwork will be completed.
Note that you cannot count any work hours towards your externship until your paperwork is complete.
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DD
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Potential Placement
Placement Name *
Your answer
Application Date *
When did you submit the application for this placement?
MM
/
DD
/
YYYY
Primary Contact at the Placement *
Include the contact's name, title, phone number, and email.
Your answer
Second Potential Placement
This is optional. We only require one potential placement in order for your application to be considered. However, if you have a backup option where you have applied and may wish to work, please include information about it here.
Placement Name
Your answer
Application Date
When did you submit the application for this placement?
MM
/
DD
/
YYYY
Primary Contact at the Placement
Include the contact's name, title, phone number, and email.
Your answer
Additional Information
If there are additional circumstances you would like us to consider, please include them in the space provided below.
Your answer
A copy of your responses will be emailed to the address you provided.
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