Clinical Practicum Forms

Documentation is required for all students engaged in clinical training. Timely and accurate completion of the following practicum-related forms for each undertaken practicum is a program requirement; the responsibility rests on the student to ensure deadlines are met.

Form Submitted To Dept By Deadline
WSIB Student Declaration Student (once/program) Start Date
WSIB Employer Declaration Student 1 month from Start Date
Clinical Placement Learning Contract Student 1 month from Start Date
Clinical Placement Student Evaluation (x2) Clinical Supervisor(s) Placement Mid-Point AND Placement End Date
Clinical Placement Clinical Hours Summary Student 2 wks after End Date
Clinical Placement Feedback (internal use only) Student 2 wks after End Date

Forms may be periodically updated so please check back to this page for the most current versions available. Questions about the documentation and/or deadline compliance may be directed to the Practicum Coordinator.

Note for Mac Users

Default settings on a MAC generally open Adobe Acrobat PDF files in “Preview” mode, which does not display or print the encrypted personalized data on your forms properly. You can

  • Open the PDF document using the “Open With” option and select “Acrobat Reader”.
  • Save the document using the “Save File” option and open the file directly from the Adobe Acrobat Reader program.