Public Health Experiential Learning Application Updated on: December 5, 2016 Term* (ex JT19, SP19, SU19, FA19)Student Name* First Last Austin College Email* Cell Phone*Austin College Suite* Student ID Number* Classification* GPA* Gender* Male Female Major(s)* Minor(s)* Career Field* Anticipated Graduation Date* MM slash DD slash YYYY Name of Site/Organization You Hope to Be Involved With* (Do not directly contact the site until your application has been approved.)Why are you interested in participating in experiential learning with the particular site/organization listed above? (650 character limit)*You should discuss your reasons for wanting to participate in experiential learning with the particular site/organization listed above with your Faculty Mentor and Public Health faculty sponsor before obtaining their approvals.Student Name* Faculty Mentor* Faculty Mentor Email* Faculty Mentor can send an email indicating their approval to either Dr. Bangara or Dr. Diggs.Public Health Faculty Sponsor*