Field Placement Clinical Learning Contract

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401 South State Street Suite 822 Chicago, IL 60605

T (312) 935- 4232 F (312) 935-4255 www.icsw.edu

Field Placement Clinical Learning Contract Between Field Instructor and Student Date:

Student:

Organization: Field Instructor: ICSW contact: Work Assignment Briefly describe the nature of your setting and the tasks in which the student will be engaged this year:

Learning Contract Using the five competencies and related practice behaviors on the following pages, please describe the specific learning experiences, practice tasks, and assignments through which the student will develop the competencies. You may note which statements are not applicable to your site and at the end of the document include training experiences specific to your site that are not listed. Please give the student and ICSW field contact a copy and retain one for yourself.

Student’s Signature:

Date:

Field Instructor’s Signature:

Date:

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