Roles and Forms

 Student

Field Placement Handbook (PDF)
Review continuously throughout MPH program

Timeline of Responsibilities (PDF)
Begins four months before enrollment

Student Interest Form (E-form, PDF)
Four months before enrollment in Field Placement course

Competency Self Assessment (DOC, PDFSample (PDF)
Four months before enrollment

Proposal (DOCSample (PDF)
At least six weeks before enrollment

Monthly Log (DOC, PDF) Sample (PDF)
Monthly during Field Placement

Midpoint Progress Report (DOC)
Before and again after Midpoint Review

Student Evaluation of Preceptor and Field Placement Experience (E-form, PDF)
Within one week of conclusion of Field Placement

In Special Circumstances:

Early Field Placement Request (E-form, PDF) Sample (PDF)
Four months before enrollment

Waiver Application (E-form, PDF)
During first semester of enrollment in MPH Program

 Site Preceptor

Letter of Introduction (PDF)
Review when student approaches potential Site Preceptor

Site Preceptor Handbook (PDF)
Review continuously

Timeline of Responsibilities (PDF)
Begins four months before student enrollment

Site Application (DOC, PDF)
Two months before student enrollment

Example of Affiliation Agreement (PDF)
Two months before student enrollment. The Program Coordinator will e-mail you an Affiliation Agreement specific to your organization. This copy is available only as an example.

Proposal (DOC) Sample (PDF)
Student will fill out; Site Preceptor will approve and sign. Student will submit at least six weeks before enrollment.

Midpoint Progress Report (DOC, PDF) Sample (PDF)
Student will submit before and again after Midpoint Review; Site Preceptor will approve

Preceptor Evaluation of Student (DOC, PDF)
Within one week of conclusion of Field Placement

 Faculty Advisor

Handbook (PDF)
Review continuously

Timeline of Responsibilities (PDF)
Begins four months before student enrollment

Proposal (DOCSample (PDF)
Student will fill out; Faculty Advisor will approve and sign. Student will submit at least six weeks before enrollment.

Midpoint Progress Report (DOC, PDF) Sample (PDF)
Student will submit before and again after Midpoint Review; Faculty Advisor will approve

Faculty Advisor Evaluation of Student (DOC, PDF)
Before the end of the semester

Contact Us

Master of Public Health Program
Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226

mph@mcw.edu
(414) 955-4510

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
Directions & Maps
© 2014

Page Updated 11/25/2014
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