MPH Program

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Roles and Forms
 

On this Page:

Student

Site Preceptor

Faculty Advisor


Student

The student participating in the Field Placement will be responsible for the following:

 

Form Available as: Sample Submission Deadline
Field Placement Handbook   PDF   Review continuously throughout MPH program
Timeline of Responsibilities   PDF   Begins 4 months before enrollment
Student Interest Form E-form PDF   4 months before enrollment in Field Placement course
Competency Self Assessment DOC PDF PDF 4 months before enrollment
Field Placement Proposal DOC   PDF At least 6 weeks before enrollment
Field Placement Log DOC PDF PDF Monthly during Field Placement
Midpoint Progress Report DOC Before and again after Midpoint Review
Student Evaluation of Preceptor and Field Placement Experience E-form PDF   Within 1 week of conclusion of Field Placement
In Special Circumstances:
   Early Field Placement Request E-form PDF PDF 4 months before enrollment
   Field Placement Waiver Application E-form PDF   During first semester of enrollment in MPH Program
 

Site Preceptor

The Preceptor at the Field Placement site will be responsible for the following:

  • Submit a Field Placement Site Application.
  • Ensure that a representative from the site signs the Affiliation Agreement with the Medical College of Wisconsin.
  • Collaborate with the student and Faculty Advisor to develop an Action Learning Project for the Field Placement experience.
  • Review and sign the Field Placement Proposal.
  • Provide an orientation to the Field Placement site. This includes reviewing the mission and vision of the organization, providing an overview of the services offered, and providing any work or safety rules and codes of conduct.
  • Develop a schedule of contact hours with the student, and verify the contact hours.
  • Provide the student with appropriate office space and resources necessary to complete the assigned tasks.
  • Arrange regular meetings with the student to monitor progress and provide constructive feedback on the Action Learning Project.
  • Complete a Midpoint Progress Report in conjunction with the student and Faculty Advisor.
  • Evaluate the student’s performance utilizing a student evaluation form provided by the MPH Program.
  • Participate in an Exit Interview with the student, Faculty Advisor and Program Coordinator within one week of the end of the Field Placement.
 
Form Available as: Sample Submission Deadline
Letter of Introduction   PDF   Review when student approaches potential Site Preceptor
Site Preceptor Handbook   PDF   Review continuously
Timeline of Responsibilities   PDF   Begins 4 months before student enrollment
Field Placement Site Application DOC PDF   2 month before student enrollment
Example of Affiliation Agreement*   PDF   2 months before student enrollment
Field Placement Proposal DOC   PDF Student will fill out; Site Preceptor will approve and sign; Student will submit at least 6 weeks before enrollment
Midpoint Progress Report DOC PDF PDF Student will submit before and again after Midpoint Review; Site Preceptor will approve
Preceptor Evaluation of Student DOC PDF   Within 1 week of conclusion of Field Placement

  *The Program Coordinator will email you an Affiliation Agreement specific to your organization.  This copy is available only as an example.

Faculty Advisor

The Faculty Advisor will be responsible for the following:

  • Provide guidance to the student, as needed, in the development of the Action Learning Project.
  • Review and approve the Field Placement Proposal.
  • Act as the Principle Investigator for the student’s application to the MCW IRB if deemed appropriate by the MPH Program.
  • Complete a Midpoint Progress Report in conjunction with the student and Preceptor.
  • Participate in an Exit Interview with the student, Preceptor and Program Coordinator within one week of the end of the Field Placement.
  • Conduct a final assessment, and assign the final grade for the Field Placement course.
 
Form Available as: Sample Submission Deadline
Field Placement Handbook   PDF   Review continuously
Timeline of Responsibilities   PDF   Begins 4 months before student enrollment
Field Placement Proposal DOC   PDF Student will fill out; Faculty Advisor will approve and sign. Student will submit at least 6 weeks before enrollment
Midpoint Progress Report DOC PDF PDF Student will submit before and again after Midpoint Review; Faculty Advisor will approve
Faculty Advisor Evaluation of Student DOC PDF   Before the end of the semester
 
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Page Updated 06/23/2014