PRACTICUM AGREEMENT*
ARGOSY UNIVERSITY –DALLAS CAMPUS: Practicum Site Name: Site Director: Director Email: Address: City, State, Zip: Phone: Dates From: To: Student Name: Student Phone: Secondary Supervisor: Supervisor Phone: Supervisor Email: Practicum Type: Indicate Scheduled Days
MAPC I
Hours per Week: Total Days Off:
The Argosy University/Dallas Training Department is pleased you accepted our student for your practicum site. We are committed to facilitating a positive relationship between you and our student; moreover we believe there is a mutual responsibility to foster and develop that relationship. Below are minimum standards for both the student and practicum site. By signing this Practicum Agreement, the student, you as the practicum site director and the Director of Training at Argosy University/Dallas agree to abide by these standards of practice and training. Students will not receive credit for any activities until this agreement is completed in full, signed by the site and the student, and submitted to the Argosy University/Dallas Director of Training. Additional policies and procedures, such as those pertaining to remediation, termination and withdrawal from the practicum can be found in Argosy University/Dallas’ Training Manual. A copy is available upon request. This student agrees with the following: Is in good academic standing, is taking required courses, and is maintaining the required grade-point-average for Argosy University/Dallas students. Has been enrolled a minimum of two semesters and has completed all prerequisite courses prior to the start of the practicum. Is enrolled in a weekly practicum seminar group taught by an Argosy University/Dallas faculty member during the practicum training year. Is currently not employed at the practicum site. Is fully covered under the Argosy University/Dallas malpractice liability insurance policy. Makes a professional and ethical commitment to the site and to its personnel and clients. Abides by a code of ethics and conduct as delineated by mental health professions. Be on site to meet the minimum number of hours for the practicum year as required by the student’s program at Argosy University/Dallas. Notify the practicum site director and the Argosy University/Dallas Director of Clinical Training about any concerns, problems, or changes in their status as a student or trainee. The practicum site director agrees to the following: Provide supervision by an appropriately credentialed clinician relative to the students training needs.† Provide a minimum of 2 hours per week of supervision. One hour must be face-to-face individual supervision, with the above-noted credentialed supervisor. The second hour can be individual or group supervision. Supervision is provided on a consistent, scheduled basis. Provide the number of hours for the practicum year as required by the student’s program at Argosy University/Dallas. For PsyD students a minimum of 75 hours in direct client contact and no more than roughly half of the hours in direct client contact. Allot the balance of the practicum hours for supervision, other learning experiences (e.g., report writing, progress notes, treatment planning, seminars, workshops, case conferences, program development). Complete a Practicum Evaluation Form at the end of each semester rating and the student’s training progress. Review the student’s Practicum Experience & Hours Log at the end of each semester documenting the hours the student performed key training activities. Provide guidance and opportunities for the student to tape clinical sessions. Students are required to present at least one clinical tape in their seminar each semester. They are also required to submit a formal sample of their work (called “CCE”) comprised of a taped session, a transcription of the session, and a written report to their seminar leaders. If taping is not possible students will be required to generate detailed process notes. Be in contact with the student’s seminar leader and/or the Training Department directors to coordinate the training of the student and to communicate important information. Argosy University/Dallas is committed to working with practicum sites to address concerns or problems about our students. Overall, (a) provide a training program that is supported and understood by the administration and staff at the agency; (b) provide a training milieu that is safe, supportive, and challenging with appropriate space to conduct clinical work; (c) emphasize responsiveness to diversity with respect to gender, race, ethnicity, sexual orientation, disability, and religion; and (d) abide by a code of conduct and ethics as delineated by mental heath professionals.
________________________________________________________ _________________________________________________ Student Signature Date Practicum Site Director Signature Date License & Number: ________________________________________________________ _________________________________________________ Argosy University/Dallas DCT Signature Date Additional Site Supervisor Signature Date License & Number:
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Please submit this form signed to your practicum seminar leader by the second week of practicum seminar. The DCT will sign and return copies for you and the site. † Unless otherwise approved by the Argosy/Dallas DCT, PsyD students must be supervised by a licensed psychologist. Revised 08/06