Experiential Learning At Work Survey

Students need to fill out this short survey prior to beginning the program and its corresponding course INT 6943. Having initial high-level project ideas and a project sponsor from your organization will increase your chances for a successful implementation. During the first week in the course you and your instructor will examine your ideas and select the one that is the most viable. This form should not take more than 10 minutes to complete. Thank you, and we look forward to talking with you further about your participation in this exciting program.

1. Please complete the following demographic information:

Full Name:
Current Workplace:
Phone Number:
2. Proposed Project Topic(s) (select 3-4 if you like):
3. Proposed Project Purpose:

In this section, include the rationale or purpose of the project or projects you are considering.
(100 words maximum)

4. Proposed Project Objective:

In this section, state what specific objectives the project(s) should accomplish. These should be measurable objectives. (100 words maximum)

5. Requirements:

Describe what is required in order for the project to be approved. Most often, this will relate to the scope of the project. For instance, the project must create "these deliverables" in order to be approved. (50 words maximum)

6. Can you verify that this project is outside your regular job responsibilities?


If "Other," please specify:

7. Pre-approval:

Name, title, and contact email of the person at the employment site who is responsible for authorizing your project. We will contact this person only if you enroll in this course.

Thank you for completing the form.