Undergrad Scholars Field-based Experience Form

See Scholars Program Requirements Online
Academic Requirements
Field Experiences Requirements

All Scholars are required to fill out this form within 30 days of completing a field-based experience. The information provided will be used both publicly on the Graham website, and shared with other scholars.

Contact the Graham Institute
Email: grahamscholarsadmin@umich.edu
Phone: (734) 615-8230

Connect with Alumni and other Scholars on Social Media
Ask alumni about their field-based experience and share your experience, see: Twitter and Facebook

Your name: *

Umich email: *

Phone: *

Program (course) type: *

U-M Course

Non-U-M Course

Independent Study

If non-U-M course or independent study, enter the name of host institution or organization:

Total Cost of program (include fees, tuition, airfare, meals, lodging, and transportation): *

Breakdown of program costs

Type in 'N/A' if expenses are not applicable.

Tuition *

Airfare *

Meals/Lodging *

Transportation *

Other

Program name: *

Enter the official course title. If U-M course, enter the course number before the title (e.g., ENV/RCID 391, Sustainability and the Campus). If an independent study, enter a title for your experience approved by your faculty advisor.

Program city, state, region and country: *

Start date of experience: *

Month

Day

Year

End date of experience: *

Month

Day

Year

Term and Year Completed (e.g., Spring 2019) *

If you completed a U-M course that took place during multiple semesters, enter all applicable semesters.

Credits Earned (must be a minimum of 3 credits) and please add details in description section: *

If available, provide a link to a program description:

If non-U-M course or independent study, please enter a program description below (information will be shared on the Graham website). If U-M course, enter N/A: *

Enter a personal reflection about your experience (this confidential statement will not be shared publicly): *

Provide your perspective about what you found most valuable, and include what you liked or disliked the most. Also, please include any recommendations for future scholars.

Opportunities for:

Opportunities for:

Undergrad Scholars Field-based Experience Form