Final Practicum Site Confirmation

Once you have found a practicum site, you are required to complete this form to confirm this as your official site. We do not consider your site confirmed until this is complete.

STUDENT INFORMATION
Name*
First Last
Email*
Semester in which you are completing the practicum:*
In-person or remote practicum?*
Estimated Start Date*
MM slash DD slash YYYY
Estimated End Date*
MM slash DD slash YYYY
Hours per week on site*
Which days will you be on site? (select as many as apply)*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Weekends
SITE INFORMATION
Name of Organization/Site*
Name of Department
Supervisor Name*
First Last
Supervisor Title*
Supervisor Email*
Website of Organization
Briefly describe the focus of your practicum this semester*
Understanding of Practicum Requirements. I understand by completing this survey that all information related to my practicum site for the semester is accurate to the best of my knowledge. I have also read and understand all requirements and expectations of the practicum.*

Final Practicum Site Confirmation

Final Practicum Site Confirmation

STUDENT INFORMATION

SITE INFORMATION