Confirmation of Placement Form for LSC, CYFS, Health Care, Mental Health Focus Areas

Instructions: This form is to be completed by the student. Students will NOT be able to begin their internship until this form is received by the Field Education Office and final approval has been given. Please contact the Field Education Office for questions regarding this form. Please notify your Field Liaison of any changes.

Student Information

Day-to-Day Field Instructor Information at your Internship Site

If someone other than Field Instructor will provide MSW Supervision