CD Field Placement Student Request Form

This form is to be completed to assist your Field Placement Specialist in placing you at an appropriate agency for your upcoming field placement.

If you have any question please contact your Field Placement Specialist:

Anita O'Keeffe anita.okeeffe [at] mohawkcollege.ca (anita[dot]okeeffe[at]mohawkcollege[dot]ca) (905) 575-1212 ext. 3573.

i.e. she/her
Transportation Type
What Field Placement is this for?
When will you be doing your field placement?
Are you planning on applying for PLAR in order to be exempt from field placement?
If you answered yes, please contact Ian DeGeer
(ian.degeer@mohawkcollege.ca) to have your work experience approved. You must have at least 336 hours of paid work experience to be exempt from field placement in the Spring semester.
Do you have a valid police clearance?
Have you applied for your Police Clearance?

Please list all languages you speak (including English) and rate your level of fluency.

Written Fluency
Verbal Fluency
Written Fluency
Verbal Fluency
Written Fluency
Verbal Fluency

You will not be placed with a field placement agency until you can provide proof that you have a valid police clearance.

Important Instructions and Information: Read Carefully

Placements assignments are based on the information provided in this form and agency interest.  We are pleased to provide you with the opportunity to state your placement preference; however despite our best efforts we cannot guarantee you will be placed in your preferred agency, city/location. Should you refuse to go to the interview, or fail the interview, you will need to meet with Anita and Kelly to determine how to move forward.

The FPS will review the information from the placement request and contact the placement agency to request the placement. Once a confirmation of placement availability is established, the FPS will inform you of your assigned agency. Do not contact agencies in an attempt to setup your own placement. Doing so will disqualify this as a placement choice and may potentially result in a loss of placement privileges for this term. Once you receive a placement assignment you will set up an initial meeting at the site. A Placement Confirmation Form must be completed at the time of your meeting and submitted to the placement seminar course. 

You may be required to travel outside of your immediate community, you are responsible for transportation and arrangements should be made accordingly.

You will be asked to provide a valid Police Clearance dated within the past 6 months to the confirmed placement site. You may be asked to have additional clearance, such as the Vulnerable Sector Check/Screen. All costs associated with obtaining the clearance, including additional clearance at the agencies request, are the responsibility of the student. Registered students who have been convicted of an offence under the criminal code for which they have not been pardoned may be denied the opportunity to enter field placement. The FPS may not confirm a placement for you if you do not have a valid police clearance. If you do not have a valid police clearance by the placement start date, placement privileges may be lost for the associated semester. It is your responsibility to inform the FPS if you meet with barriers which may prevent you from obtaining a clear police clearance.

For the benefit of all parties your placement may not be at a site where you currently or previously worked. Placements that pose a potential conflict of interest also include sites where family members work, or where you have volunteered or completed previous placement assignments.  It is your responsibility to inform the placement specialist of any conflict of interest. A placement can be terminated should it be evident that there is a breach of this policy.

All pre-placement requirements must be met prior to placement starting. All costs associated with this process is the responsibility of the student. 

Once this form is submitted, monitor your email daily. The FPS may require additional information from you prior to confirming your placement.  Delays in responding may result in placement delays.

The confirmed placement will be emailed to your @mohawkcolleg.ca email account. 
You may not begin placement until the associated term begins. You must meet all academic and non-academic placement requirements before beginning placement. 
 

I have read and agree with the Instructions and Information above.

You will not receive a field placement agency unless you can agree to the above statement(s). If you have any issues please contact your Field Placement Specialist.

Educational Background

Please provide your educational background and any other relevant certifications and education.

Include any degrees, diplomas, and/or certifications you have. Include completion year and the city it was obtained in.

Placement Information

Please indicate the populations of people you are hoping to work with.