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COMMUNICATION SCIENCES & DISORDERS
OFF-CAMPUS CLINICAL PRACTICUM AGREEMENT
Student Name: Student Phone:
Supervisor Name: Supervisor Phone:
Site: Semester:
Student Schedule: (specify days and hours, all times student is expected to be present, policy for making up missed days due to illness, holiday coverage.)
Student Responsibilities: (state expectations in terms of caseload, lesson plans, report writing, staffing, special projects, etc.)
Supervisory Schedule: (conferences, observations, written evaluations)
Required Orientations/Readings/Other:
Student/date Supervisor/date
If components of this agreement are not met, the supervisor and student should initially attempt to resolve issue by review of stated expectations. The ϲ CSD practicum coordinator will mediate issues that continue to be a problem.
*Form adapted from University of New Hampshire CSD Department
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