Form RM17 I Date of Request: II Requested by: Name: Phone 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Date of Request' in the designated field. This should reflect the current date or the date you are submitting the request.
3. In the 'Requested by' section, fill in your 'Name' and 'Phone #' accurately to ensure proper communication.
4. Specify the 'Department' you are associated with, as this helps in processing your request efficiently.
5. Detail the 'Activities to be Performed by Student(s) during this externship.' Be specific about tasks and responsibilities.
6. List all students to be covered under this request, including their names and Social Security numbers (S.S.#).
7. Indicate the externship facility where these activities will take place.
8. Fill in the coverage effective dates, including 'Start Date' and 'End Date,' ensuring they align with your externship schedule.
9. Lastly, provide an 'Account # to Charge' for billing purposes if applicable. Once completed, review all entries for accuracy before submission.

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