ࡱ> 574y ybjbj ."{{y 88888RTTTTTT$m"nxx88yyy88RyRyyV:@81F+x)z >0x"?:""@yxxy" :  Field Placement Agreement Section A: Party to the Agreement Student Name: __________________________________ E-Mail: _____________________________ Address: _________________________________________ Phone: ____________________ Host Organization: Supervisors Name: __________________________ E-Mail: ___________________________ Address: _________________________________________ Phone: ____________________ 鶹ý Instructors Name: __________________________ E-Mail: ____________________________ Address: _________________________________________ Phone: ____________________ Section B: The Placement The placement will begin on ____________________ and end on ___________________ The placement will involve the following activities and outcomes: [Develop a brief job description. This could include expected activities and tasks, how the placement meets the needs of the host organization, and/or the expected time commitment] Section C: Responsibilities (Sample) Responsibilities of the Student The Student will: Undertake the placement conscientiously and with due respect to the expectations of the host organization and the University Keep his/her instructor informed of the placements progress and notify them of any concerns about the placement or the host organization in a timely fashion Attend and participate in all necessary meetings (with his/her instructor, placement supervisor) Work with or within the auspices of the Host organization or community for a minimum of _______ hours to a maximum of 35 hours per week, for a minimum of ________ weeks (Sample) Responsibilities of the Host The Host will: Orient the student to the organization and work site(s). Ensure the student understands any risks or hazards that may exist and the safety practices followed. Promptly report any incidents to the instructor Supervise the student, meeting with the student a minimum of 15-30 minutes a week to monitor the students progress Provide feedback at an on-location meeting with the practicum director/instructor Complete the site supervisor evaluation form upon completion of the placement (Sample) Responsibilities of 鶹ý/Instructor The Instructor will: Screen applicants to ensure that only motivated, well-qualified students will take part in the practicum program Maintain contact with the site supervisor and provide support to both the student and the organization/site supervisor Work with the site supervisor in resolving any issues that may arise Provide guidance of an academic nature. Evaluate the students learning and grade his/her work By signing below, you are stating that you agree to the above terms regarding this placement. 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