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REQUEST FOR CLINICAL PRACTICUM AGREEMENT Student Name: Course Info: Number Preceptor Info: Name of Course Semester Year Name & Title Name of Agency Contract Liaison Name of Agency Street Address City

How to fill out request for practicum agreement

How to Fill Out a Request for Practicum Agreement:

1. Begin by obtaining a copy of the practicum agreement form from your educational institution or the organization where you will be completing your practicum.
2. Carefully read through the form, paying attention to all the required information and any instructions provided by your institution or the organization.
3. Start by filling in your personal information accurately, including your full name, contact details, and student identification number, if applicable.
4. Provide details about your educational program, including the name of your school or institution, the department or program you are enrolled in, and your expected graduation date.
5. Indicate the specific dates and duration of your practicum, making sure to include the start and end dates of the placement.
6. Fill in the contact information for your practicum placement supervisor or coordinator, including their name, position, email address, and phone number.
7. Provide information about the organization or company where you will be completing your practicum, such as its name, address, and contact details.
8. Include any additional information required by the form, such as specific learning objectives, course requirements, or any special considerations or accommodations needed.
9. Review the completed form to ensure all information is accurate and legible. Make any necessary corrections or additions before submitting it.
10. Once you have filled out the request for practicum agreement completely, sign and date the document. If required, have a supervisor or faculty member sign as well.

Who Needs a Request for Practicum Agreement:

1. Students pursuing a practicum or internship as part of their educational program usually need to complete a request for practicum agreement.
2. Educational institutions require this document to ensure that the practicum placement meets the necessary educational standards and guidelines.
3. The organization or company hosting the practicum may also require a request for practicum agreement to establish the responsibilities and expectations of both parties during the placement.

For pdfFiller’s FAQs

What is request for practicum agreement?

The request for practicum agreement is a formal document outlining the terms and conditions of a student's placement at an organization for practical training purposes.

Who is required to file request for practicum agreement?

Students who are seeking practical training opportunities are required to file a request for practicum agreement.

How to fill out request for practicum agreement?

The request for practicum agreement can typically be filled out online or through a paper form provided by the academic institution or organization offering the practicum opportunity.

What is the purpose of request for practicum agreement?

The purpose of the request for practicum agreement is to formalize the student's placement, outline the responsibilities of both parties, and ensure that the practical training meets the academic requirements.

What information must be reported on request for practicum agreement?

The request for practicum agreement typically requires information such as the student's personal details, the organization hosting the practicum, the duration of the placement, and any academic requirements or objectives.

Where do I find request for practicum agreement?

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