Practicum Description/Agreement Form

The form below is to be filled out by the prospective practicum supervisor from the partnering institution. It is required ahead of any practicum placement and will be forwarded to our Practicum Coordinator.

Practicum Student
Name*
First Last
Student Carleton Email*
Practicum Institutional Partner
Institution Name*
Institution Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Institution Contact Person*
Name, title, email, phone
Institution Supervisor (if different from contact person)*
(Specify name, title, email, phone. Input N/A if not applicable.)
Practicum Project
Number and Duration of Practicum (1 or 2 semesters at 144 hours per semester)*
(Choose one of the five options above.)
Description of Practicum Project*
Final Term Paper: Potential Research Topic Areas*
Specific Tasks to Be Performed*
Practicum Expectations and Requirements
Requirements and Expectations*
(eg. specialized knowledge, experience, aptitude)
Resources Made Available to Student*
(Input N/A if not applicable)
Specific Forms and Approvals Required*
(eg. security clearance, etc. Input N/A if not applicable)
Additional Information as Relevant*
(Input N/A if not applicable)
Acknowledgement
Date
MM slash DD slash YYYY
Consent*
I agree.
By checking this box I confirm that I am able and committed to report on and supervise this practicum placement, which has been discussed with and agreed to by all parties involved (student and institution)
Email
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Practicum Description/Agreement Form

Practicum Student

Practicum Institutional Partner

Practicum Project

Practicum Expectations and Requirements

Acknowledgement