About this form: 

This form is intended to be completed by a placement coordinator and reviewed and signed by a student. Agency placement dates should be established for every agency that a student works with, for optimal reporting options and for database cleanliness. When completed in a site placement process, the student’s name and the site’s name will auto populate in this form.

Experiential Learning Cloud Best Practice:
Use this form in the agency step of site placement processes in which students are assigned an agency, that way the placement coordinator can assign the dates at the same time that they assign the site.