Professional Documents
Culture Documents
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
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.
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.
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.
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.
Student
Student
Student
4
Student
Field Supervisor
Director of DrPH
Field Experience
5
PHS 750 Public Health Practicum: The Field Experience
Project Objectives
(200 words) List 3-5 objectives that relate to your individual goals.