Practicum Learning Contract

The completed Learning Contract will become the guiding document, much like a syllabus, for the learning outcomes and assessment of your practicum experience. Prior to your participation in the practicum/internship experience, your contract must be submitted and then approved by your Faculty Supervisor and On-Site Supervisor, and the Associate Dean for Learning, Calling, and Career. Once approved, you will receive an e-mail notification and you will be registered for the appropriate internship course in your major.

Before completing the contract, please be prepared to provide the following:

Confirmation that you have reviewed the Internship/Practicum Manual and have spoken with your faculty advisor about this practicum opportunity
Names and contact information for each supervisor
Summary of intern’s responsibilities
SMART Goals* for development of interpersonal skills and personal qualities desired by all employers
SMART Goals* for development of industry specific skills related to your major

*(See pp. 8-10 of Internship/Practicum Manual for guide to writing SMART goals)

"*" indicates required fields

Section 1: Contact Information

Student Name*

First Middle Last

Student Montreat Email*

Student ID*

Personal contact # during practicum:*

Will this practicum be part of your work-study hours through Montreat College?*

Academic Major (area of study for the practicum)*

This is a…*

Has Pre-requisite INDS-3610 been completed?*

INDS-3610 MUST be completed prior to registering for a practicum.

Have you reviewed the Internship/Practicum Manual, including the assignments listed on p. 15?*

Have you discussed this practicum opportunity with your Faculty Advisor?*

NOTE: If you have checked “No” for the above 3 items, please do so before submitting this form.

This practicum will be completed during:*

Name of Faculty Advisor*

Email of Faculty Advisor*

Will your faculty supervisor be different than your faculty advisor?*

Most students ask their advisors to supervise their practicum, but not always. You may ask another faculty member from your academic department if appropriate for the work you will do in your practicum.

Name of Faculty Supervisor*

Email of Faculty Supervisor*

On-site Practicum Supervisor*

Coach if EXSC 3071

Email of On-Site Practicum Supervisor*

Second on-site Practicum Supervisor, if required

Trainer if EXSC 3071

Email of Second On-Site Practicum Supervisor

Organization*

Organization's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organization's Phone*

Section 2: Responsibilities and Schedule

Summary of the responsibilities and duties of the practicum*

Tentative Weekly Schedule

Section 3: SMART Goals

In collaboration with your Faculty Supervisor, develop and list a total of 6 specific, measurable outcomes (SMART Goals) you want to achieve in the following areas:

SMART Goals are Specific, Measurable, Attainable, Relevant, and Time-based.

State each goal to include answers to the following questions:

What do you want to accomplish?
How are you going to accomplish it? (What steps will you take to accomplish your objective? What activities will you do? How will you acquire the learning? Under what conditions will the learning occur?)
How you will measure your objective? (What evidence will you have to demonstrate that learning has taken place? What criteria will be used to evaluate your evidence? Who will do the evaluation?

Three SMART Goals* for development of “Career Ready” interpersonal skills and personal qualities desired by all employers*

See pp. 8-12 of Internship/Practicum Manual for guide to writing SMART goals and a list of Career Ready Skills desired by all employers and guide to writing specific goals.)*

Example of Stated Cross Career Goal: Improve communication skill of listening with intent. By the end of my practicum experience I will increase my listening abilities by taking notes in meetings with my team or my supervisor, repeating back to the speaker what I heard them say, and asking my supervisor for feedback on my listening skills.

Three SMART Goals* for development of industry specific skills related to your major*

*(See pp. 8-10 of Internship/Practicum Manual for guide to writing SMART goals)

Example of Stated Industry Specific Goal: By the end of my practicum, I will have documented the layout of my organization’s cyber-network, conducted a vulnerability assessment, and successfully presented my findings to my supervisors

Section 4: Policies and Signature

INSURANCE: Workers’ compensation coverage is provided only if student is being paid for the practicum. Montreat College provides only health insurance (for a fee) to its students. Medical Professional Liability in Student Practicum Agreement: Professional Liability: $5 Mil Occurrence.

I understand that Montreat College provides health insurance at student rates. I may elect out of the insurance if I have other health insurance coverage. I also know that Montreat College will not provide professional liability or workers’ compensation coverage for me. I will be responsible for providing my own insurance if it is not provided by the agency for which I am performing my practicum. If federal work-study monies are paying me while on this practicum, I will be covered by workers’ compensation insurance through the College. I must secure the written agreement of the Financial Aid Director/Counselor to verify that I am being paid on work-study funds.

AGENCY RESPONSIBILITIES: The agency will provide a learning/working site where the student will be able to accomplish the agreed upon learning objectives in a safe environment free of discrimination and harrassment.

DISCRIMINATION: The parties listed on the first page shall not engage in discrimination in the treatment of any participant connected with the internship/practicum. Discrimination means any act that unreasonably differentiates selection and treatment intended or unintended based on age, handicap, national origin, race, marital status, religion, sex, or sexual orientation.

SEXUAL HARASSMENT: Sexual harassment is illegal. Sexual harassment includes unwelcome sexual advances and requests for sexual favors. It also includes other verbal or physical conduct of a sexual nature. Sexual harassment is prohibited between the student and any client and is prohibited between the student and the supervisor, and the student and the faculty member.

TERMINATION PRIOR TO THE END OF THE PLACEMENT: The agency may request Montreat College to withdraw the student who is not performing satisfactorily or who refuses to follow the organization’s administrative and operating policies, procedures, rules, and regulations. The student may request to leave the practicum/internship if he/she believes there are irreconcilable differences or if the student believes he/she is in any danger. In both instances, the professor should be notified immediately and an attempt at resolution should be made.

MONTREAT COLLEGE RESPONSIBILITIES: Montreat College is responsible for working with the supervisor and/or agency to place a student who is at the level needed by the agency. The faculty member will make a mid-term contact to discuss how the practicum is progressing. Should there be an issue, the faculty member will attempt to resolve the issue immediately or place the student into another placement and work through any credit hour issues.

STUDENT RESPONSIBILITIES: The student will sign up for credit for the practicum if that is what the faculty member and the student have agreed upon. The student will treat the position as any job, will completed the assignments as spelled out in this contract, will keep the hours agreed upon by the student and the supervisor, and will notify that supervisor should he/she be absent. The student will keep the advisor informed if there is a potential problem developing. The student will conduct him/herself in a professional manner remembering that this may be a confidential site and treat it as such. In addition to the requirements for the course, the student will keep and sign a time sheet and turn it in to the professor at the end of the term.

PUBLIC RELEASE AUTHORIZATION: In order for the agency to use your name, photograph or quotes you must sign a release form and vice-versa. With a signed consent the agency may use these in any form of publicity. If the student is to use information from or about the agency, he/she must have the appropriate consent forms signed by the agency and/or student.

Student Electronic Signature: Typed*

Student Electronic Signature: Date*

I agree and acknowledge that this document can be executed electronically and it is binding in every way as if signed by my hand. I have read and understand this document. I also acknowledge by signing this contract that an additional fee of $50.00 per credit hour will be charged when registering for either a Practicum or Internship during the fall/spring Academic Year. The tuition rate for Practicum and Internships during the summer will be charged at the rate specified in the Academic Catalog. Payment is due before the start of each semester/term. The student acknowledges that he/she has successfully completed INDS-3610, Pre-Internship.

Name

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