PERMISSION TO TAKE OFF-CAMPUS ELECTIVES
                                       1996 - 1997
                                      (Please print)



Name: _________________________________________

Course Title: IDS-350                            _________________________
                                                 Dates
_________________________________________        _________________________
Name of Institution                              Number of Weeks

                                                 _________________________
                                                 Preceptor's Name
                                               
                                                 _________________________
                                                 Preceptor's Phone No.

Does this fulfill a requirement? ____________________


Course Title: _____________                      _________________________
                                                 Dates
_________________________________________        _________________________
Name of Institution                              Number of Weeks

                                                 _________________________
                                                 Preceptor's Name

                                                 _________________________
                                                 Preceptor's Phone No.


Does this fulfill a requirement? _____________________


Comments: ____________________________________________


Signed: ______________________________________________


Department of: _______________________________________






Note:  When this information is identical to the educational program
approved by the student's advisor and the Dean for Student Affairs (as
recorded in the Dean's Office), and when received by the Dean's Office
prior to the beginning date of the elective, GWU malpractice insurance
will be in force.