SUPERVISED PROFESSIONAL PRACTICE - PROPOSED PLACEMENT AND CONSENT FORM This form must be completed by a student at the pre-placement interview with the placement agency and returned to the Supervised Professional Practice Coordinators before the student may commence the placement via email – or in person. This form ensures that a student is covered by insurance and that the proposed placement arrangements meet required Social Work Field Education standards. Once this form has been received and approved by a SPP Coordinator; a confirmation email will be issued to the student and agency representative or Social Work Educator, advising that the placement can commence and providing details of the allocated University Contact (Liaison) and External Social Work Educator (if applicable). This form must be returned to the University as soon as possible after your pre-placement meeting or your placement will not be confirmed and will not proceed. All sections must be completed in full. Scan and upload to InPlace Student Details: Student ID: Student Surname: First Name: Phone (day): Mobile: Student Email: @student.monash.edu BSW BSW(Hons) BA/BSW BA/BSW(Hons) Course: (please select) MSWQ MSW BHSc/BSW BHSc/BSW(Hons) Unit Code: SWK3180 SWK4560 SWM5103 SWM5108 Current Employer: Position: Details of Proposed Placement (Agency to complete): Agency: Contact Person: Email: Street Address: Suburb: State: Postcode: Postal Address: Phone: ( ) STUDENT PLACEMENTS CONSIST OF 500 HOURS OF SUPERVISED PROFESSIONAL PRACTICE FIELDWORK 3 / 4 / 5 Start Date: Days per Week (please circle): Day 15 Date: Day 35 Date: Finish Date:
SUPERVISED PROFESSIONAL PRACTICE - PROPOSED PLACEMENT AND CONSENT FORM This form must be completed by a student at the pre-placement interview with the placement agency and returned to the Supervised Professional Practice Coordinators before the student may commence the placement via email – or in person. This form ensures that a student is covered by insurance and that the proposed placement arrangements meet required Social Work Field Education standards. Once this form has been received and approved by a SPP Coordinator; a confirmation email will be issued to the student and agency representative or Social Work Educator, advising that the placement can commence and providing details of the allocated University Contact (Liaison) and External Social Work Educator (if applicable). This form must be returned to the University as soon as possible after your pre-placement meeting or your placement will not be confirmed and will not proceed. All sections must be completed in full. Scan and upload to InPlace Student Details: Student ID: Student Surname: First Name: Phone (day): Mobile: Student Email: @student.monash.edu Course: (please select) BSW BSW(Hons) BA/BSW BA/BSW(Hons) MSWQ MSW BHSc/BSW BHSc/BSW(Hons) Unit Code: SWK3180 SWK4560 SWM5103 SWM5108 Current Employer: Position: Details of Proposed Placement (Agency to complete): Agency: Contact Person: Email: Street Address: Suburb: State: Postcode: Postal Address: Phone: ( ) STUDENT PLACEMENTS CONSIST OF 500 HOURS OF SUPERVISED PROFESSIONAL PRACTICE FIELDWORK Start Date: Days per Week (please circle): 3 / 4 / 5 Day 15 Date: Day 35 Date: Finish Date:
proposed-placement-offer-consent-form-2017.docx