WILMINGTON UNIVERSITY AHS PROGRAM GUIDED PRACTICUM - CAPSTONE PROJECT AGENCY/UNIVERSITY AFFILIATION AGREEMENT ‘A Memorandum of Understanding is agreed upon by the Wilmington University AHS Program and the following agency: (Please print clearly) Name of Agency: A J elma ck at. address: 2000 Worn land 2 cinisite: Be cusayes fA zi 19312 _ Sener wcecwie & Name of Supervisor: Hedie Hoag — ra: Sesaca rene roner tol 225 4433 TO PROVIDE: (Check Alll that Apply) ‘uided Practicum (14 Week/120 Clock Hours) for the perio ‘apstone Project Host Site: for the period: /___ through 1 Month/Year Month/Year WILMINGTON UNIVERSITY AGREES To provide an AHS Program Chair and a Guided Practicum Faculty Field Instructor to collaborate in the student's training experience and to serve as a liaison for the agency. ‘To provide a concurrent practicum/capstone class to be held on campus during the specified period of the Practicum. To provide the student with a Guided Practicum/Capstone Faculty Field Instructor to provide additional individual and/or triadic supervision. |. To insure the student has agreed to abide by the Ethical Standards of Human Service Professionals. FIELD PLACEMENT SITE/AGENCY AGREES To provide on-site individual supervision to the student for a minimum of one hour per week during the specified period of the Practicum. To provide a credentialed Site Supervisor* who meets the AHS Programs requirement for Site Supervisors. Criteria for supervisors include a Master's prepared human service professional with relevant experience. To provide the student with tasks related to the administration of human services from a management/Ieadership perspective. ‘To provide suitable work space to conduct professional activities. AGENCY SUPERVISOR SIGNATURE AHS PROGRAM CHAIR * Please attach agency supervisor’s resume?