______________________________________ ____________________________ Primary Supervisor Date ______________________________________ ____________________________ Secondary Supervisor (if applicable) Date ______________________________________ ____________________________ Secondary Supervisor (if applicable) Date ______________________________________ ____________________________ External Site Practicum Coordinator (if applicable) Date ______________________________________ _____________________________ PSC Director Date ______________________________________ _____________________________ Director of Clinical Training Date (Note: DCT approval required only for PSYC 7954 & 7956) Please submit to: Andrea Labossiere - Psychological Service Centre, University of Manitoba, 164 Dafoe Building , Winnipeg, MB R3T 2N2 PH: 204-474-6392 FAX: 474-6297 Email:
______________________________________ ____________________________ Primary Supervisor Date ______________________________________ ____________________________ Secondary Supervisor (if applicable) Date ______________________________________ ____________________________ Secondary Supervisor (if applicable) Date ______________________________________ ____________________________ External Site Practicum Coordinator (if applicable) Date ______________________________________ _____________________________ PSC Director Date ______________________________________ _____________________________ Director of Clinical Training Date (Note: DCT approval required only for PSYC 7954 & 7956) Please submit to: Andrea Labossiere - Psychological Service Centre, University of Manitoba, 164 Dafoe Building , Winnipeg, MB R3T 2N2 PH: 204-474-6392 FAX: 474-6297 Email:
Clinical_Psychology_Practicum_Contract_Plain_Word_Version-November_2018.docx