UNDERGRADUATE FIELDWORK/SERVICE LEARNING CONTRACT

STUDENT INFORMATION:

Name: _______________________________________________________________________________________

Address: _____________________________________________________________________________________

Daytime Phone: ________________________________ Evening Phone: _____________________________

Cell Phone: ____________________________________________________________________________________

Marist Email: ________________________________________ Fax: __________________________________

(Note: Students are required to use their MARIST EMAIL address.)

FIELDWORK SUPERVISOR & SITE INFORMATION

Site Supervisor Name: _________________________________________________________________________

Email: ______________________________________________________________________________________

Title: _________________________________ Degrees/Licenses/Credentials: _____________________________

Name of Agency: _____________________________________________________________________________

Address: ____________________________________________________________________________________

Phone: _______________________________________ Fax: ________________________________________

FIELDWORK SEMESTER (check): □ Fall □ Spring □ Summer YEAR: _________________

EXPECTED STUDENT STATUS DURING FIELDWORK: □ Junior □ Senior

CHECK WHICH PSYCHOLOGY PROGRAM YOU ATTEND:

□ Poughkeepsie Main Campus □ Kingston Extension Program □ Fishkill Extension Program

REGISTRATION (check all that apply): Note: Each course number represents 3 credits worth of Fieldwork.

□PSYC487N □PSYC488N □PSYC489N □PSYC490N □PSYC491N

Fieldwork 1 Fieldwork 2 Fieldwork 3 Fieldwork 4 Fieldwork 5

SCHEDULING INFORMATION (of fieldwork spread over 14 weeks; check one):

□ 9 hrs/wk (3 credits) □ 18 hrs/wk (6 credits) □ 27 hrs/wk (9 credits) □ 36 hrs/wk (12 credits)

Total=125 hours Total=250 hours Total=375 hours Total=500 hours

Start Date: __________________________________ Expected Finish Date: __________________________

Notes: Fall and Spring Fieldwork cannot start earlier than the first day of the semester, and must end by the

middle of finals week. Summer Fieldwork may start after graduation in May and must end by August 13.

The 4 Mandatory Group Supervision classroom meetings usually take place on Mondays or Wednesdays

from 5 – 6:15PM. DO NOT SCHEDULE CLASSES OR FIELDWORK HOURS DURING THIS TIME.

Fieldwork Schedule: ___________________________________________________________________________

List the schedule of all courses taken concurrently with fieldwork:

_____________________________________________________________________________________________

DISCLOSURE OF TIME OFF (FOR VACATIONS/SPRING BREAK, ETC.)

List dates of time off so that ALL PARTIES are aware of student’s intent to be away from Fieldwork duties:

___________________________________________________________________________________________

Learning Objectives (delineated by Student):

1. ______________________________________________________________________________________

2. ______________________________________________________________________________________

3. ______________________________________________________________________________________

4. ______________________________________________________________________________________

5. ______________________________________________________________________________________

Job Description (delineated by Fieldwork Site Supervisor in collaboration with Student):

1. ______________________________________________________________________________________

2. ______________________________________________________________________________________

3. ______________________________________________________________________________________

4. ______________________________________________________________________________________

5. ______________________________________________________________________________________

6. ______________________________________________________________________________________

7. ______________________________________________________________________________________

8. ______________________________________________________________________________________

9. ______________________________________________________________________________________

10. _____________________________________________________________________________________

POLICY AND PROCEDURE NOTES:

· The Student cannot begin a Fieldwork without approval from the Marist Psychology Fieldwork Coordinator.

· Fieldwork must be started and finished within the academic calendar semester schedule.

· The Student is responsible for maintaining contact (particularly by email) with the Marist Faculty Supervisor (Instructor).

· The Student will maintain a journal log of their activities for review by their Marist Faculty Supervisor.

· The Student will maintain a timesheet that will be signed by the site supervisor and submitted for review by the Marist Faculty Supervisor.

· The Student will attend all group supervision meetings held by the Marist Faculty Supervisor.

· The Student will complete all assigned papers and evaluations and submit them to the Marist Faculty Supervisor.

· The Marist Faculty Supervisor will visit the Student and Site Supervisor during the semester. If the site is more than an hour from Marist, the Faculty Supervisor will not perform a site visit. In this case, the Site Supervisor and Faculty Supervisor will communicate periodically to discuss the fieldworker’s progress.

· The parties to this contract agree to fulfill their respective expectations and responsibilities as describe by the Fieldwork Manual.

· Job activities and responsibilities can only be altered by specific agreement of all three parties involved.

· The undersigned Site Supervisor agrees to consistently provide weekly one-to-one supervision meetings to provide instruction, facilitate development of necessary skills and knowledge, and enhance the personal and professional growth of the intern. The Agency Site Supervisor will submit an Evaluation of the Intern to the Marist Faculty Supervisor.

Student’s signature and date: ____________________________________________________________________________

Agency Site Supervisor’s signature and date: _______________________________________________________________

Marist Fieldwork Coordinator’s signature and date*: _________________________________________________________

*Submit Contract to the Fieldwork Coordinator LAST for review and signature. The contact information is below:

FIELDWORK COORDINATOR CONTACT INFORMATION:

Janine Ogden, M.S., L.M.H.C.

Marist College PSYC Dept.

3399 North Road

Poughkeepsie, NY 12601-1387

(845)575-3000, x7696

Fax: (845)575-3965

Janine.Ogden@Marist.edu