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• Name, Organization and Title.

• Name:
  *
• Employing Organization:
• Job Title:
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• Please include your preferred address, phone number and email for us to contact you.

• Address:
• City:
• State:
• Zip:
• Phone number:
• E-mail:
  *
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• Would you be interested in joining an IAP committee?

• 1. Curriculum and Field Committee
  (reviewing focus group feedback and making recommendations)
  Yes  No 
• 2. Recruitment and Public Relations Committee
  (recruiting, interviewing, and selecting students)
  Yes  No 
• 3. Advisory Board
  Yes  No 
• Would you be interested in becoming a field instructor for IAP?
  (must be graduated for 2 years)
  Yes  No 
• Would you be interested in becoming a non-IAP field instructor
  for the School of Social Welfare? (must be graduated for 2 years)
  Yes  No 
•  

• Please share any news for our semi-annual Alumni Newsletter

• Comments:

When you are finished with the survey, please press “Submit.”

Or print the survey, hand-write your answers, and mail to:
Linda Mertz
UAlbany School of Social Welfare
IAP Program
135 Western Avenue, RI 287
Albany, NY 12222
Thank you.