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Rev. 06/10/15 Program Agreement, Exhibit A & Attachment EXHIBIT A to Program Agreement by and between CHW and (Name of school) Student Placement Certification Form

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What is student placement certification form?

The student placement certification form is a document that verifies a student's successful completion of a placement or internship.

Who is required to file student placement certification form?

Students who have completed a placement or internship are required to file the student placement certification form.

How to fill out student placement certification form?

To fill out the student placement certification form, students need to provide their personal details, details of the placement or internship, and a signature from their supervisor.

What is the purpose of student placement certification form?

The purpose of the student placement certification form is to officially recognize and verify a student's successful completion of a placement or internship.

What information must be reported on student placement certification form?

The student placement certification form must include the student's name, the name of the organization where the placement or internship took place, the start and end dates of the placement, and a brief description of the student's responsibilities.

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