Learning Agreement Outline (To be completed at the beginning of the Academic Year) I. IDENTIFYING INFORMATION Academic Year: Please check: □ Foundation Year/1st Year Second Year □ Student Name: Field Faculty Liaison: E-mail: E-mail: Phone number: Phone number: Agency Name: Field Instructor: E-mail: Phone number: Preceptor: E-mail: Phone number: Agency Address: City: Zip: Telephone: Fax: II. THE AGENCY AND THE COMMUNITY (Agency) A. Describe the agency’s mission: B. Describe the organizational structure: C. List the services provided to community: D. Describe the general demographics (ethnicity, race, socio-economic status, age) of the clients: agency’s (Community) E. Describe the geographic location of your agency:
Learning Agreement Outline (To be completed at the beginning of the Academic Year) I. IDENTIFYING INFORMATION Academic Year: Please check: □ Foundation Year/1st Year □ Second Year Student Name: E-mail: Phone number: Field Faculty Liaison: E-mail: Phone number: Agency Name: Field Instructor: E-mail: Phone number: Preceptor: E-mail: Phone number: Agency Address: City: Zip: Telephone: Fax: II. THE AGENCY AND THE COMMUNITY (Agency) A. Describe the agency’s mission: B. Describe the organizational structure: C. List the services provided to community: D. Describe the general demographics (ethnicity, race, socio-economic status, age) of the agency’s clients: (Community) E. Describe the geographic location of your agency: