Master of Divinity Middler Scheduling Confirmation

MIDDLER INFORMATION

This form is required as confirmation that you have:

Identified a Middler Panel, to be chaired by your primary advisor, that consists of your Field Education or CPE mentor/supervisor, a PSR student peer, a Denominational representative (only if you are on the Ordination track), and a secondary advisor (only if assigned by the Assistant Dean),
Confirmed that all on your panel have agreed to the date and time listed, to be either physically present or available via a Zoom video conference, and
Scheduled a Zoom link and/or a Conference Room.

Please submit this form as soon as you have completed the above. Not doing so may prevent you from registering for the next semester and continuing in the program due to an academic block. Once submitted, you and your primary advisor will receive a copy via the email addresses you provided. The Assistant Dean for Academic Affairs & Registrar will also receive a copy for tracking purposes.

Further clarification regarding this form may be found in the Student Middler Review Guidelines, This document can be either downloaded from the Student Resources web page (MDiv Resources and Forms), or emailed to you by contacting Grace Gilliam, Associate Director of Community Engaged Learning, ggilliam@psr.edu.

Which type of Field Praxis have you completed
*This question is required.

Please enter an 'other' value for this selection.

Academic year of your Concurrent Field Education or Internship (e.g., 2021-2022) or
Semester & Year of your CPE program (e.g., FA21)

*This question is required.

PLEASE ENTER YOUR CONTACT INFORMATION:

FIRST NAME *This question is required.

LAST NAME *This question is required.

STUDENT EMAIL *This question is required. This question requires a valid email address.

CELL PHONE (for day-of-meeting texts)

CONFIRMED SCHEDULE *This question is required.

Date of Middler Review
Time of Middler Review (include time zone)
Location of Middler Review
Zoom link for Middler Review

MIDDLER PANEL MEMBERS INFORMATION

FACULTY ADVISOR FULL NAME *This question is required.

FACULTY ADVISOR EMAIL *This question is required. This question requires a valid email address.

MENTOR/SUPERVISOR FULL NAME *This question is required.

MENTOR/SUPERVISOR EMAIL *This question is required. This question requires a valid email address.

PEER FULL NAME *This question is required.

PEER EMAIL *This question is required. This question requires a valid email address.

DENOMINATIONAL/PROFESSIONAL REPRESENTATIVE FULL NAME
(if applicable)

DENOMINATIONAL/PROFESSIONAL REPRESENTATIVE EMAIL This question requires a valid email address.

2nd FACULTY ADVISOR FULL NAME
(if applicable)

2nd FACULTY ADVISOR EMAIL This question requires a valid email address.