Theological Field Education: Ministry Site Agreement

Student and Supervisor-mentor should complete this form together. It solidifies the agreement between the student, ministry site/supervisor-mentor, and seminary to participate together in Theological Field Education. Please complete all required fields below. This form is due on or before July 1 prior to the academic year in which you intend to complete Theological Field Education.

Student Information

Today's Date * +

Salutation

Student Full Name *

Preferred pronouns

Student Phone *

Student Email *

Proposed job title (or current title, if currently employed at your ministry site) *

Ministry Site Information

Name of Ministry Site *

Street Address *

Address Line 2

City *

State *

Zip Code *

Main Phone Number at the Ministry Site *

Ministry Site web site (if any)

What is the purpose/mission of the organization? Please include specific population(s) served, broader community setting, organizational priorities, etc.) *

Supervisor-mentor Information

Supervisor-mentor Salutation

Supervisor-mentor email *

Supervisor-mentor First Name *

Supervisor-mentor Last Name *

Supervisor-mentor Preferred Pronouns

Supervisor-mentor Position Title *

Supervisor-mentor Relevant Degrees and/or Certification Credentials

What type of ordination, licensure, and/or endorsement do you hold? (e.g. elder, pastor, deacon, priest, chaplain, etc.)

If you have previously supervised a Phillips Theological Seminary student, please provide names below.

If your Mentor and Supervisor are two different people, please provide information about your supervisor below.

Supervisor First Name

Supervisor Last Name

Supervisor Phone Number *

Supervisor email

Supervisor Position Title

Student Learning Goals

To get an idea of what you would like to accomplish in your field placement, and to insure that you are placed in a ministry setting that is conducive to your learning goals, please list three learning goals/priorities that you would like to pursue during field education. In the space below, enumerate (number 1-3) and write three basic goals (one sentence each) that you would like to accomplish through Theological Field Education. (Ex. 1, "I want to become a better preacher." 2. "I want to learn how to start a community outreach program based in a congregation." 3. "I want to become exposed to what it looks like to lead a nonprofit social service-based ministry.") There is no right answer here--these are the areas of growth that YOU, the student, would like to pursue through Theological Field Education.

These goals should be different than your dugies or responsibilities, although there should be some overlap. For example, if you hvae a goal around developing your voice in public spaces, one of the duties or responsibilities might related to teaching, presenting, or preaching, depending upon your setting. *