Guidelines for MPH Programs in Canada

Appendix 6: Sample Practicum Learning Contract

The following sample field practice placement learning contract has been adapted from ASPH. (See reference document 3). Some programs have additional fields for information on the workplace environment (e.g. equipment/space to be provided) and scheduled meetings between the field-based practicum supervisor and student.

This document is to be signed by all parties (university-based practicum supervisor, field field-based practicum supervisor, and the student). A copy of this agreement should be retained for future reference and monitoring by all parties.

• Student’s Name: 
• Name of Field Practice Site: 
• Address of Site: 
• Field-based practicum supervisor:
  • Name: 
  • Title:  
  • E-mail: 
  • Phone:  
  • Fax: 
• Project Title: 
• Dates of Field Practice Placement: from to Hours of Work per Week: 
• Stipend: (if any) 
• Learning Objectives of the Field Placement (typically 4-6) 
• Methods and Timetable Necessary to Accomplish Objectives
  (Defines the level of mastery that will be obtained. Written as a statement of measurable results): 
• Deliverables: Final Product(s) (e.g. report) to Be Delivered and to Whom (Guided by Learning Objectives): 
• Student’s Signature  Date 
• Field-based practicum supervisor’s Signature  Date 
• University-based practicum supervisor’s Signature  Date 
• Program director’s Signature  Date 

Attachments: Responsibilities of student, field-based practicum supervisor, and university-based practicum supervisor; Project proposal