Student or Faculty Request for a New Site | CalState S4

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All organizations with whom students are placed for off-campus curricular activities outlined in S16-14 must have a current University-Organization Agreement (UOA) with the University. Submission of this form will initiate the UOA process for a new site. Please only submit this form for sites that are not included in the SJS4 site list.

First Name

Last Name

Select one:

I am a SJSU Student

I am a SJSU Faculty Member

SJSU Student

SJSU Email Address

Course Department

(e.g. Child and Adolescent Development)

Course Title and Number

(e.g. CHAD 60)

Instructor Name

Instructor Email Address

Name of Agency/Service Site

Name of Site Supervisor

(i.e. Your contact at the site.)

Email of Site Supervisor

(i.e. Your contact at the site.)

SJSU Faculty Member

SJSU Email Address

Course Department

(e.g. Child and Adolescent Development)

Course Title and Number

(e.g. CHAD 60)

Name of Agency/Service Site

Name of Your Contact at Site

Email of Your Contact at Site