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Jackson State University

School of Public Health


DrPH Field Experience Agreement
(to be implemented fall 2018)

Overview and Instructions


The student (residency) team and field supervisor develop a field experience
agreement in the weeks preceding the beginning of the experience. The
Agreement should include the student team’s learning needs and deliverables as
they relate to the priorities of the host organization.

The document should be typed separately and attached to this cover page as a
single PDF signed by all parties.

1. Field supervisor and all students on the team sign the completed
agreement.
2. The student team submits the signed agreement for approval to Dr. Mary
Shaw by two weeks prior to the start of the field experience.
3. Dr. Shaw reviews the agreement and provides feedback to the student as
needed for any revisions. Upon initial approval or following further
revisions, Dr. Shaw signs the agreement and retains a copy for each
student’s file.

STUDENT NAMES:

Chizoba Anyimukwu

PROJECT TITLE:

1. Target BP and Check.Change.Control.Cholesterol (Healthy Living Behaviors)


2. Metro Jackson Health Equity Committee (HEC)

DATES OF FIELD EXPERIENCE (minimum of 135 hours/semester)


Must be completed before comprehensive exams take place.

Beginning Date: September 26, 2018

Ending Date: December 6, 2018

1
FIELD EXPERIENCE HOURS
(Describe the mutually agreed-upon method for tracking hours worked)

The American Heart Association intern timesheet will be used to track hours. The
student will create a timesheet that reflects the timesheet provided by the
Practicum Instructor.

ORGANIZATION NAME AND ADRESS


American Heart Association
4830 McWillie Circle
Jackson, MS 39206

FIELD SUPERVISOR AND MENTOR CONTACT INFORMATION


Name, salutation/pronouns, credentials, email and phone number)
Rosa M. Wilson
Director, Community Impact
American Heart Association
rosa.wilson@heart.org
Office 601.321.1213
Mobile 601. 566. 9765

FORM OF FINAL DELIVERABLE(s) TO ORGANIZATION


Project A:
1. A Resident created record of recruited clinics for Target Blood Pressure
(Target BP) and Check.Change.Control.Cholesterol.
2. A form for documenting the disseminated evidence-based tools and
educational resources.
3. Documented record of presentations using visual aids such as infographics,
posters, and PowerPoints.
4. Record of partnership meetings.
Project B:
1. AHA Metro Jackson HEC meeting agenda, meeting reports and progress
reports.
2. Key performance indicators report.
3. An evaluation guidance for the Metro Jackson Health Equity Committee key
performance indicators.

SUPERVISION
Describe the mutually agreed-upon process for supervision and mentorship.

Ms. Wilson will serve as the onsite Preceptor. She will supervise all aspects of
the project. Dr. Shaw and Ms. Rosa will serve as mentors for the projects and
practicum experience.

2
HUMAN SUBJECTS REVIEW
After reviewing the JSU IRB criteria and participating in the Human Subjects
training, indicate if the experience will require an IRB review and specify why or
why not.

No, the experience will not require an IRB approval from Jackson State
University. It will involve the use of existing data or records approved by the
American Heart Association Quality Improvement standards.

FIELD EXPERIENCE DESCRIPTION


On a separate document provide the following information:
1. Brief overview of the project’s background, significance and goals.
(250 words)
2. Objectives of the project
(200 words) List 3-5 objectives that relate to your individual goals.
3. DrPH required competencies
List of DrPH field experience competencies that are to be attained during
the field experience.
4. Project worksite location(s) and resources.
(100 words) Specify arrangements for your daily work environment
including location(s), whether travel is required, and access to information,
personnel (with whom you will be interacting), data, and other materials
necessary for completion of the project. If special permission is required
for access to data, records, or clients, has permission been arranged?
5. Final products and deliverables
(100 words) Describe the final deliverable(s) that the team will be
responsible for contributing to the organization, and how it fits into their
strategic goals and/or mission.

STUDENT/TEAM EXPECTATIONS
• Maintain a work schedule agreed upon with the field supervisor
• Complete the specified tasks of the project, including written assignments
and oral presentations.
• Meet with the site supervisor regularly to discuss progress on project,
leadership goals and objectives.
• Execute on all project deliverables
• Complete an evaluation of the field immersion experience.
• Advise supervisor and/or DrPH Program staff of any conflicts that could
impact completion of deliverables or other aspect of the Learning
Agreement.
• Maintain professional conduct in all interactions with the field supervisor
and other employees or business partners of the host organization.
• Serve as representatives of the JSU School of Public Health community
and abide by the code of conduct for students

3
SUPERVISOR EXPECTATIONS
 Develop and agree to facilitate the field immersion experience.
 Provide adequate working space and office resources for the students as
needed to support successful completion of the assigned projects.
 Develop an entry/onboarding plan with the student that facilitates
immersion into the organization and your work environment.
 Provide the student with an orientation to the setting and organizational
culture, procedures and policies, and guidelines around safety and
security.
 Meet with the student regularly to provide necessary guidance and
supervision, as well as establish and maintain project goals, objectives
and timeline.
 Identify other experiences, outside of the project, that will expose the
student to senior leaders, decision making and organization management,
and/or professional development opportunities.
 Complete an evaluation of the Team upon their completion of the
experience (the DrPH Field Experience Director will contact you with
further information).
 Advise DrPH program staff and/or students of any conflicts which could
impact the Team’s project.

DrPH PROGRAM EXPECTATIONS


 Confirm with the student Team and host organization supervisor that the
proposed experience will meet the field experience requirements.
 Maintain communication with the student resident and supervisor
throughout the experience, as needed, including addressing any concerns
or problems.
 Work with the student Team and supervisor to request formal feedback on
the progress of the field experience at its completion.

AGREEMENT SIGNATURES
I have participated in the development of the Field Experience Agreement and
agree to the conditions specified above. If it is necessary to change any of the
specified conditions, I agree to make the changes known to each of the persons
whose signatures appear below.

Role Name Signature Date


(print) (MM/DD/YYYY)
Student

Student

Student

Student

4
Student

Field Supervisor

Director of DrPH
Field Experience

5
PHS 750 Public Health Practicum: The Field Experience

Field Experience Description

Brief overview of the project’s background, significance and goals. (250


words)

Project Objectives
(200 words) List 3-5 objectives that relate to your individual goals.

DrPH required competencies


List of DrPH field experience competencies that are to be attained during the field
experience.

Project worksite location(s) and resources.


(100 words) Specify arrangements for your daily work environment
including location(s), whether travel is required, and access to information,
personnel (with whom you will be interacting), data, and other materials
necessary for completion of the project. If special permission is required
for access to data, records, or clients, has permission been arranged?

Final products and deliverables


(100 words) Describe the final deliverable(s) that the team will be
responsible for contributing to the organization, and how it fits into their
strategic goals and/or mission.

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