DOCUMENTS & FORMS

The link to the USC Practicum Handbook and relevant forms are available below:

Practicum Syllabus: Practicum Syllabus Practicum Manual: Practicum Manual

Forms to be completed by the Agency:

Field Supervisor Evaluation Form: Completed by the supervisor upon completion of hours. Agency Application to be a Field Placement Site: Completed prior to student placement. This form displays an inventory of activities in which students may participate and is filed in the USC Practicum binder. Please indicate if you do not wish to be contact by students directly. Internship affiliation agreement: Completed by the agency and signed by a designated staff member and the Vice Provost of Planning and Budget at USC. This form is completed prior to placing a student in a site. This form is not necessary for placements within USC.

Forms to be completed by the Student:

List of Practicum SItes: A List of Practicum Sites Tips for writing Goals and Objectives: Tip sheet on how to write Goals and Objectives Instructions for Creating the Scope of Work: Instructions for Creating the Scope of Work MPH Competency Checklist: MPH Competency Checklist Scope of Work - SAMPLE: Sample Scope of Work Practicum Learning Agreement: This form outlines the scope of work for the project to be completed by the student. This form is completed by the student with the assistance of the field supervisor at the beginning of the field experience and is approved by the Coordinator. The agreement must be submitted according to the following schedule: • 400 hour practicum: before 100 hours • 200 hour practicum: before 50 hours Student Travel Information Form: This form details travel information and emergency contacts for students traveling outside of the Los Angeles area to complete their practicum. This form is to be completed by the student prior to departure. Student Release for International Travel: This form outlines policies and procedures to be followed by the student completing field training outside of the United States . This form is to be completed by the student before departure. Student Release for Domestic Travel: This form outlines the policies and procedures to be followed by students completing field training outside of the Los Angeles area, but within the United States . This form is to be completed by the student before departure. Student Agreement-Legal Form: This form outlines policies and procedures to be followed by students completing field training. This form is to be completed by the student and requires proof of health insurance. Waiver Criteria: This form provides instructions for completing the waiver request. Documentation is submitted to the Program Director and Practicum Coordinator prior to the beginning of field training hours. Practicum Interest Form: To be completed ONE semester BEFORE you register for 593(aka Student Interview Form).