Practicum Placement Contract & Conditions

Student Name:	Mary Jones
Program:	Dental Assistant - Level I & II
Cohort:	OTT.DAD.0123 Dental Assistant - Level I & II
Business Name:	City Family Dental
Address:	1234 Main Road, Halifax, NS

This contract is between the following three parties, and requires signatures, which indicates the full agreement with the conditions outlined below. (All three parties will receive copies of this contract).

Required to successfully complete Practicum(s):

Practicum Start Date	Practicum End Date	Number of Weeks	Number of Hours
Feb 6, 2023	Jun 30, 2023	20	200
Jul 17, 2023	Aug 8, 2023	3	25
Aug 9, 2023	Oct 27, 2023	13	115
Oct 30, 2023	Nov 17, 2023	3	75

Please note that students cannot complete their practicums early. Students must complete the number of weeks, and finish all required practicum assignments, assessments, and standards-mandated competencies (if applicable) as required by the College, including the Self-Reflection Assessment, before the practicum is complete.

The College agrees to:

• Coordinate the practicum placement opportunity
• Appoint a Practicum Coordinator who will act on behalf of the College to oversee the student, and provide the contact information to the Company
• Monitor the student’s progress through journals, timesheets, etc.
• Respond to calls for support from the student and agency supervisor/designate
• Ensure the student has workplace insurance coverage
• Help clarify the student’s expectations, host’s expectations, and the College’s expectations, and hold student accountable when necessary
• Provide the student with a written final evaluation based on the placement feedback from the supervisor

The Company agrees to:

• Discuss company policies, including Occupational Health and Safety policies, and their expectations with the student
• Provide scheduled supervision to the student
• Designate a qualified member of the company’s staff to act as the student’s supervisor and main point of contact, and provide that information to the student and the College
• Contact the college if student performance problems become evident
• Provide the student with a safe and valuable learning experience
• Supervise the student’s interactions with clients as appropriate
• Provide the student with continuous feedback
• Complete the student evaluation form, discuss the evaluation with the student, and return to the Practicum Coordinator at the end of placement
• Maintain communication with the Practicum Coordinator and return the student’s weekly timesheet
• Provide the student with the practicum(s) listed above

The Student agrees to:

• Exhibit a professional work ethic at all times during the practicum term. The student must remember that they are working for the benefit of their host employer
• Complete the required number of hours and the required number of weeks. Students must respect start and end dates, as finishing practicums early is not an option!
• Be an active learner and regularly communicate with your immediate supervisor and Practicum Coordinator
• Complete required attendance reports with signatures by the end of each business week. A week will be defined as a Monday to Friday period.
• Report any lateness or absence to both the host employer and the college Practicum Coordinator. (Excessive lateness/absenteeism is just cause for an unsatisfactory grade evaluation or dismissal from placement)
• Missed shifts and hours are required to be made up according to your provincial Regulatory Body. Where hours are required to be made up, the student must work with the practicum host to confirm a revised schedule which must be completed prior to the scheduled end date. Exceptional circumstances must be brought to the attention of the college.
• Sign any compulsory non-disclosure, privacy, and/or other related standard company forms
• Follow and abide by applicable local, provincial, and federal laws, and staff policies of the employer. Students are required to protect the private information of the employer’s clients, employer trade secrets, internal processes, or any proprietary information
• If you are dismissed by your practicum site, or leave your practicum before completing the minimum hours or minimum number of weeks without consulting the college before you do so, you may be withdrawn from your program.

College Representative: Stephanie Smith

Signature: Signed on Jan 26, 2023

Student Name: Mary Jones

Signature: Signed on Jan 30, 2023

Company Representative: Ali Johnson

Signature: Signed on Jan 26, 2023