Off-campus Engagement Request Form
Complete this form to request permission for regular essential off-campus engagement. Please submit a SEPARATE form for each request.
Name
*
First Name
Last Name
Wheaton Email
*
example@my.wheaton.edu
Student ID #
*
Spring semester housing address (off-campus street address and unit # OR on-campus building, room/apt #)
*
Are you a varsity athlete?
*
Yes, fall sports
Yes, winter sports
Yes, spring sports
No
Are you a music student at Wheaton College?
*
Yes
No
Academic Major
*
Anticipated graduation month/year
*
Name of off-campus work or internship
*
City where off-campus site is located
*
Name of your off-site supervisor
*
If approved, your supervisor may be asked to verify they are abiding by current public health safety guidelines.
Supervisor's contact phone number
*
-
Area Code
Phone Number
Type of off-campus site (if "other" enter description)
*
Work
Student teaching site
Internship
Other
Are you doing this internship for credit?
Yes
No
Reason for request
*
Academic requirement for graduation
Financial need
Other
Please describe your duties for your internship/work?
*
What is your intended work/internship schedule?
*
What specific measures will be taken to keep you COVID-Safe? (i.e., will you be wearing masks, social distancing, adhering to capacity guidelines, engaging outside when possible?)
*
Additional comments that will assist with our review of your request:
*
I understand that upon approval of my request, I will be required to provide a negative COVID-19 test to Student Health Services on a weekly basis in order to retain approval.
Submit
Should be Empty: