PLTS Internship Petition for Geographic Restriction

Geographic Restrictions

With the concurrence of their candidacy committee, students may petition the PLTS faculty to limit their mobility with respect to internship placement.

A request for geographic restriction means that you have chosen geographic location as the highest priority for internship placement: the specific features of sites and supervisors thus become secondary considerations given the limitations of geography and the availability of sites.

One consequence of identifying geographic location as the highest priority for internship placement is that the usual financial resources assumed in an unrestricted internship will not be available. Specifically, housing is not included, and while every effort will be made to secure the $2000 monthly stipend, this amount is not guaranteed.

First Name

Last Name

Pronouns

Requested Geographic Location (region/city/etc.)

Projected Internship Start Month/Year (e.g. Jan 2026)

Explanation for request for restriction: to be submitted to faculty for consideration

By providing my electronic signature, I understand that in restricting my internship placement geographically, the standard financial remuneration will not be available. Specifically, housing is not provided, and the full monthly stipend amount is not guaranteed.

Student Signature

I have discussed this restriction with my candidacy committee and have their approval. The contact person for my candidacy committee is:

Name

Phone

FERPA Release

By providing my electronic signature, I grant permission for staff of the PLTS Office of Contextual Education to speak with the contact person of my candidacy committee, named above.

Student Signature