Self-Proposed Student Topic Form

If you want to participate in a clinic or seminar through the Public Service Clinics and have your own self-generated topic, please fill out this form and submit it by November 5.

The Public Service Clinics' matching process works best when both the agency and the student understand and agree to the project's focus and goals. For this reason, we want to ensure that you and your agency contact have already met and thoroughly discussed and understand your topic.

Additionally, you must have discussed the $1250 participation fee with your agency and instruct them to contact psclinic@u.washington.edu indicating whether they will be paying the fee or requesting financial assistance before your proposal will be considered. Please contact us if you have any questions.

Please note that once you are accepted into the Public Service Clinics, you are required to meet with your clinic or seminar instructor and agency contact in December to develop a letter of agreement.

All fields followed by * are required.

Name: *

Email: *

Gateway: *

Do you have a clinic or seminar preference?: *

Agency Information

Agency / Organization Name: *

Agency Contact Name: *

Agency Contact Title: *

Agency Contact E-mail Address: *

Agency Contact Phone Number: *

Agency Address

Street Address: *

City: *

State: *

Zip code: *

Agency Web Address:

Agency Background Information: *

Please provide background information about the agency.

What is the specific research question that you will be working to answer in your degree project?: *

Additional Project Background: *

Please describe the project in more detail, what is the current situation that the organization or program faces and how will your degree project help the organization and its target population?

What will be the final deliverable or final product at the end of your degree project? : *

What are the major/key steps that you envision that you will need to accomplish to finish this project?: *

What are some possible research resources that you will use to answer the research question and finish your degree project?: *

Why are the Public Service Clinics of interest to you?: *

If you have selected a specific clinic, please also discuss your choice.

Please provide a short paragraph about yourself and your experience.:

Click here for sample bios.

Please provide the name of a faculty member familiar with your work we can contact with questions about student-topic matches: *

I have discussed the $1250 fee with my agency contact and they agree to pay or request financial assistance. : *

Yes

I certify that both I and my agency contact have reviewed the topic proposal and are submitting it for consideration.: *

Yes

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Self-Proposed Student Topic Form