Forms

 

Placement Agreement Form

The Placement Agreement Form is the formal document stating that an agency has accepted you as a practicum student.  In the semester prior to your practicum placement, you will need to complete and return this form to your Field Administrator.  

Placement Agreement Form

Timesheet Template

UISSW does not require students to track hours, although some agencies do.  That being said, it can be very beneficial if there are any disputes about how many hours a student has completed if the student has maintained a record of hours. The following template can be used as a record of hours

Placement Hours Log

Employment-Based Placements

If you are interested in completing a practicum in an agency where you are already employed, there are additional steps.

Guidelines and Application for Employment-Based Placement

Learning Contract

Early in your placement you will develop a Learning Contract, which clearly lays out what you will be doing during the semester to meet the required competencies and practice behaviors of the program.  The actual document will be completed in the school's Intern Placement Tracking (IPT) Database system but Word versions are here for your reference as well as additional supports to help you develop your learning contract.

Foundation Learning Contract– Word Version (actual document must be completed in IPT)

Foundation Learning Contract Example

Adv. Practicum Family-Centered Learning Contract– Word Version (actual document must be completed in IPT)

Advanced Learning Contract Example

Adv. Practicum Integrated Practice Learning Contract– Word Version (actual document must be completed in IPT)

MSW Integrated Practice Example

Learning Contract Worksheet

Site Visits

During your placement, you will be assigned a Field Coordinator from UISSW who will conduct site visits with you and your Field Instructor in order to ensure to support your learning experience.  The following forms represent what will be discussed during these site visits.  These are for your reference only and will be provided at the site visits by your coordinator.

Foundation Site Visit Forms – Initial Final

Advanced Site Visit Forms – Initial & 2nd/3rd