PRACTICUM STUDENT PLACEMENT AGREEMENT
Prior to any Athabasca University student commencing a practicum related to their program of study, a legally binding agreement must be in place between Athabasca University and the practicum facility (referred to as the “Facility”) to ensure each party understands their responsibilities and legal obligations.
This Practicum Student Placement Agreement (“Agreement”) describes your responsibilities and obligations with respect to your practicum placements. You are required to read and sign this Agreement prior to commencing a practicum.
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By signing this Agreement, I agree to the following:
1. I will not commence any practicum without the prior express written permission of Athabasca University.
2. I acknowledge that practicum programs cannot compromise the client care or client service objectives of the Facility. The Facility and Facility staff are the final authority for all aspects of client care and client service and for the integration of practicum programs into the Facility.
3. I acknowledge that each of Athabasca University and/or the Facility have the right to require me to leave the Facility and/or terminate my practicum because of my performance or conduct. In the event of such termination, I understand that:
a. I will be required to withdraw from GCAP 685;
b. I will receive no course credit for any course work, clinical hours, or assignments submitted up to that time;
c. I will be permitted to re-enroll in GCAP 685 no sooner than the following Fall semester;
d. and I may be required to undertake additional course work or professional development at the discretion of the Athabasca University Practicum Coordinator before being permitted to re-enroll in GCAP 685.
4. I acknowledge that confidentiality is a fundamental term of my practicum with the Facility. I acknowledge and agree that in performing my practicum duties at the Facility, I may acquire confidential, personal and/or health information about the Facility and its business, clients, employees and other representatives, all of which is not in the public domain and which is confidential. I agree that I have a continuing obligation not to directly or indirectly disclose or use the confidential information of the Facility for any purpose whatsoever during or after the term of my practicum, unless such disclosure is agreed to by the Facility or is required by law. I understand that breaching confidentiality is a serious offence and is may result in the termination of my practicum.
5. I acknowledge that clients of the Facility have the right to refuse to be participants in practicum programs.
6. I will be assigned practicum responsibilities only to the degree commensurate with my level of ability and optimum learning will be provided without diminishing the quality of client care or client service. I will not undertake or perform any task which is outside the scope of the responsibilities specifically assigned to me. If I believe a task is beyond my level of ability or learning, I will immediately inform my practicum supervisor.
7. I acknowledge that I am subject to and agree to abide by all the Facility’s relevant policies, procedures, legislation and regulations, as amended from time to time, while I am participating in the practicum program.
8. Prior to commencing a practicum at any Facility and at my own expense, I agree to obtain and submit to the Facility and/or Athabasca University upon request the following documentation:
a. criminal reference check and the result thereof if required by the Facility;
b. signed confidentiality agreement if required by the Facility;
c. any other documentation or information reasonably required by the Facility and/or Athabasca University.
9. I agree that the Facility and/or Athabasca University has the right to refuse my access to a practicum should the results of any of the above documentation or information, as listed in paragraph 8, cause concern to the Facility and/or Athabasca University.
10. I acknowledge and understand that, depending on my province of residency and location of practicum, I may or may not be covered by that province’s Workers’ Compensation coverage. If my practicum is in a province in which Athabasca University has not been able to obtain Workers’ Compensation coverage, I understand that prior to commencing a practicum, I must sign Athabasca University’s Release and Indemnity Agreement (RIA) and accept the insurance coverage offered in lieu of workers’ compensation coverage.
11. I understand that I am required to immediately inform my practicum supervisor, the Athabasca University Practicum Coordinator, and where applicable and required, the appropriate Workers’ Compensation authority, of any injury I incur at a practicum site.
12. I understand that I am required to attend Practicum Seminars in Weeks 9 and 23 of GCAP 685 in their entirety, that I am required to present a videorecording of audible quality at each of the Practicum Seminars, and that failure to do so may result in being required to withdraw from the course.
13. I understand that I am required to be enrolled in GCAP 685 to be covered by the University’s liability insurance. Accordingly, no practicum requirements may be undertaken, or be credited to me, outside of enrollment in GCAP 685.
14. I acknowledge that, as a condition of being granted a practicum placement, the Facility may require me to perform professional duties for over and above the requirements for GCAP 685, for which I may not receive course credit.
Signature : ______Date: ______
Practicum Student Placement Agreement p. 1