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Click here to return to the Enhanced Placement Student Forms Page

Enhanced Placement Program Student Agreement
2011 - 2012 School Year

As a student entering the Enhanced Placement (EP) Program of Philadelphia Connections, I understand that:

1.       Although my school or graduate program may have recommended me for the EP program, there is no penalty of any kind for not participating if I so choose.

2.       Participating in the EP program will involve mandatory attendance at four days of Enhanced Seminars: two in Fall, and two in Winter.

3.       The four days of the EP Enhanced Seminar Series are scheduled on my regular field placement days and my field placement agency will give me permission to attend the seminars. However, I may still need to make arrangements with my field supervisor concerning the rescheduling of certain placement events or tasks on those days. I will discuss this with my field supervisor in advance of any EP activities.

4.       During the course of the school year, other educational and training opportunities will be made available to me at no cost.

5.       I agree to participate fully in the EP evaluation process which includes:

  • Providing basic information about my background
  • Filling out learning evaluation and satisfaction forms before and/or after EP presentations
  • Filling out feedback forms concerning the EP program
  • Taking part in-group and individual evaluations of the EP program, including a group
    exit interview.

6.       All information I provide to Connections will be regarded as confidential. No information will be shared with my school or field placement, except in the case of summary reports, which may include generalized information without identifiers---for example: "80% of the EP students were "very satisfied" with the EP orientation program." Normal confidentiality rules may not apply if the Coordinator at any time feels that a danger is posed to any student or client by a situation.

7.       I will receive a stipend of $250.00 per semester ($500.00 total for the school year) ($150 for BSW students--$300 total for the school year), assuming that I am matriculated in a participating school program at the start of each semester. I must submit a properly completed Connections invoice form no earlier than the first day of each semester. It will take up to eight weeks after Connections has received my invoice before I receive my stipend check. The invoice for the second stipend payment will not be submitted for reimbursement until I have attended all four EP Enhanced Seminars.

8.       I will contact the Connections Office Manager or EP Administrator concerning problems about any part of the EP program, except for scheduling conflicts. If I think I may have a problem attending one of the required EP activities, I will first talk to my field supervisor or my school placement liaison or professor, depending on the nature of the scheduling conflict. If I cannot work it out with them, I will ask them to call the Connections EP Administrator or ask the Administrator to call them. In all cases when I cannot attend a required EP activity, I will call the Connections office in advance and inform the EP Office Manager. Failure to do so may jeopardize my EP status.

9.      I understand that I must have a working email address or access to someone with one that I can check at least twice weekly for announcements and updates on the EP program. If I have absolutely no way of obtaining a reliable email address that I can check at least twice a week (including through a friend/classmate or free email services using a library computer), I will contact the EP Coordinator to discuss this problem.

I have received the following forms and documents:

·  EP Student Handbook

·  EP Invoice Forms

·  EP Student Information Form

Please complete the information below and return via e-mail, or mail to Ms. Green ℅ the Connections office at 123 S. Broad Street, 23rd  Floor, Philadelphia, PA 19109

Please inform Ms. Luciane Green, Connections Office Manger, at LGreen@pmhcc.org, or 215-599-5176, about any missing forms.

Student signature:  ________________________________________________________

Date signed: _______________________________________________

Name of School:  ___________________________________________

Name of Field Placement Agency: ______________________________

 

Click here to return to the Enhanced Placement Student Forms Page