SCHOOL OF SOCIAL WORK: FIELD EDUCATION PROGRAM

Document Sample
SCHOOL OF SOCIAL WORK: FIELD EDUCATION PROGRAM Powered By Docstoc
					          47-473 FIELD EDUCATION I
                 HOURS LOG


Student Name:
Agency:
Field Instructor:

                                                                                                                  Number of                        Total Hours
                 Week                                     Placement Dates
                                                                                                                    Hours                            to Date
    Week 1

    Week 2

    Week 3

    Week 4

    Week 5
    Week 6

    Week 7

    Week 8
    Week 9
    Week 10

    Week 11

    Week 12

    Week 13
    Week 14

    Week 15
    *Total Number of
                                             Student to Add Total Hours………………....
    Hours

Student Signature:
Field Instructor Signature:
On-Site Task Supervisor Signature:
(if applicable)
Date:

     *It is the student’s responsibility to ensure the Hours Log is submitted with the
         evaluation. Grades will not be assigned without the signed Hours Log.*
                                                                        NOTICE OF DISCLOSURE
                                                               CONFIDENTIALITY AND USE OF PERSONAL DATA

The personal information collected on this form is being collected under the authority of the University of Windsor Act, 1962. This collection is compliant with the Freedom of
Information and Protection of Privacy Act of the Province of Ontario.
The purpose of this data collection is related directly to and needed by the School of Social Work, University of Windsor to administer the university / student relationship
including the proper recording of student academic progress and to adhere to governmental reporting requirements.
Data collected on this form will be disclosed and used as follows:
             by administrative and field office personnel for student field placement planning and record-keeping;
             by field instructors in community agencies for placement planning;
             for academic counseling.
If you have any questions about the collection, use, and disclosure of this information please contact: Director of the School of Social Work OR the FIPPA Coordinator,
University of Windsor, 401 Sunset Avenue, Windsor, Ontario, Canada N9B 3P4 (519) 253-3000 ext. 4059. richardt@uwindsor.ca

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:9/15/2012
language:Unknown
pages:1