Practicum Contract

1. Student ___________________________________________________

2. Agency ____________________________________________________

3. Field Instructor: Educational ___________________________

Task (if necessary)______________________

4. Course: Social Work ____ 440 or ____ 441.

5. Number of credit hours _____

6. Number of work hours _____ = Number of working days ____

7. Contract period: From _________________to ________________
Day/ Month/ Year Day / Month/ Year

8. The student's schedule will include the following hours on the indicated days on a weekly basis:

Mon. _____________ Tues. _______________ Wed. ______________
Thurs. ____________ Fri. ________________ Sat. ______________
Sun. _____________

9. Supervisory conferences with the field instructor will be held at __________ on (Time) ___________ on a weekly basis. (If other arrangements are necessary, (day) please indicate: _______________________.)

10. The agency has supplied the student with a complete set of agency rules, regulations, policies, and standards that apply to the student’s work in the agency. Yes_____No_____

11. The agency will reimburse the student in the following manner:

a. Travel at ____ per mile for agency work.

b. Other work-related expenses: _______________________________________________________

12. Insurance coverage:
The college covers the student for malpractice liability when the student is fullfilling educational requirements and is not employed by the agency. If the student is employed by the practicum agency either the agency or the student must carry insurance coverage.13. The student and field instructor will work out a detailed learning plan for the student. The student's overall learning goals for this practicum include the following areas:

SIGNATURES

Student ________________________________ Date _______________

Field Instructor ___________________________ Date _______________

Practicum Director __________________________ Date _______________

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