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County of Los Angeles Department of Mental Health Student Professional Development Program American Indian Counseling Center Social WorkInternship Specialization: Children, Youth and Families Agency:American
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How to fill out practicum agency information sheet

01
Obtain the practicum agency information sheet from your supervisor or program coordinator.
02
Start by filling out your personal information including your name, contact details, and student ID number.
03
Provide information about your practicum agency such as the name, address, and contact information.
04
Include details about your supervisor at the practicum agency including their name, position, and contact information.
05
Fill out the start and end dates of your practicum placement.
06
Sign and date the form once all information has been accurately filled out.
07
Submit the completed practicum agency information sheet to your supervisor or program coordinator for review and processing.

Who needs practicum agency information sheet?

01
Students who are participating in a practicum placement as part of their academic program.
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The practicum agency information sheet is a document that provides details about the agency where a student will be completing their practicum or internship.
The student, along with the educational institution or program coordinating the practicum, is usually required to file the practicum agency information sheet.
The practicum agency information sheet is typically filled out by providing details about the agency, the student, the supervisor, the duration of the practicum, and any specific requirements or expectations.
The purpose of the practicum agency information sheet is to ensure that all parties involved have a clear understanding of the practicum arrangement and to facilitate communication and coordination.
The practicum agency information sheet usually requires information such as agency name, address, contact person, student name, educational program details, supervisor name, and practicum start and end dates.
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