MPH Program

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Field Placement Forms


Information and links are provided below for the forms that must be filled out by:

 


Students

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 Responsibility Checklist with Deadlines 2013-2014 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

Timeline of Responsibilities:  2013 - 2014  l   2014 - 2015



Site Preceptors

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.

Timeline of Responsibilities:  2013 - 2014  l   2014 - 2015


Faculty Advisors

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

Timeline of Responsibilities:  2013 - 2014  l   2014 - 2015

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Page Updated 03/17/2014