CLAREMONT GRADUATE UNIVERSITY. Master of Public Health Program (MPH) Supervised Field Training Handbook

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1 CLAREMONT GRADUATE UNIVERSITY Master of Public Health Program (MPH) Supervised Field Training Handbook

2 Welcome to the Public Health Internship! An integral part of the MPH program is the internship, a structured and supervised professional experience with an approved agency for which students receive academic credit. As a working partnership between students and public health agencies, the field training experience offers students a rotation through an area of public health practice in a county, state, federal or community based agency. The goal of the internship is to further students practical experience while enhancing the work of public health. Through field training and the associated requirements, students have the opportunity to demonstrate an integration of coursework into a real world setting, preparing them for a professional career in public health. This manual was developed as a guide for MPH students, faculty, staff and field supervisors as an overview of the policies, procedures, requirements and guidelines for the MPH internship. As this is a work in progress, revisions will be made to this manual as needed. Wishing you a rewarding internship experience, Darleen Peterson, PhD, MPH, MCHES Assistant Professor & Program Director Master of Public Health Program School of Community and Global Health Claremont Graduate University DISCLAIMER: While every effort is made to ensure the accuracy of the information contained in this student handbook, the MPH Program reserves the right to make modifications at any time without prior notice. Updated 2/13 MPH Internship Handbook Page 2

3 TABLE OF CONTENTS Section Page Academic Purpose and Value 3 Goals & Objectives 3 Types of Facilities & Experiences 3 Types of Learning Opportunities through the Internship 4 Internship Sequence 4 The Fieldwork Facility 7 Selection of Field Training Facilities 7 Requirements of the Field Training Facility 7 Facility Monitoring and Removal 7 Financial Compensation for the Student 7 Integration with Regular Employment 7 The Field Supervisor 8 Selection and the Role of the Field Supervisor 8 Responsibilities of the Field Supervisor 8 Requirements of the Field Supervisor 8 Role of MPH Program Administration 8 Description of Paperwork & Forms 9 Academic Requirements 10 MPH Coursework 10 Time Commitment 10 Tracking Course Progress & Completion 10 Grading 10 Appendix Agency Application to be a Field Placement Site Internship Affiliation Agreement Field Supervisor s Evaluation of Student Time Table for Completion of Field Training Documents Student Interest Form Waiver Criteria Student Legal Agreement Student Release for International Travel Learning Contract Scope of Work Template Sample Scope of Work Inventory of MPH Student Competencies CGH 306 Syllabus Sample Journal Time Card Poster Presentation Tips Grading Rubric for Poster Presentation MPH Internship Handbook Page 3

4 Academic Purpose and Value Goals and Objectives Integral to the MPH curriculum is the internship or field placement. The Council on Education for Public Health (CEPH) specifies that an MPH program shall assure that each student acquires skills and experience in the application of basic public health concepts and of specialty knowledge to the solution of community health problems. An internship is provided by a field training experience in an area of public health practice in a county, state, federal, community based agency or university environment. The goal of the public health internship is to enrich students educational training by providing an opportunity to apply theory and skills acquired from their concentration to community based research and service in a practice setting. Students contribute to an agency s resources and to the solution of public health problems while developing personal confidence and leadership as a public health professional. The objectives of the Supervised Field Training in Public Health are designed to provide students the following opportunities: Introduce the role of public health and social service agencies in the community setting Expand the understanding of organizational and policies issues, administration, research, funding mechanisms, program activities and challenges faced by organizations addressing public health issues Apply and test public health concepts and theories in a practice setting Improve communication and professional skills through on the job training Contribute to the analysis of public health problems Assume leadership roles and responsibilities for the design, implementation and/or evaluation of public health programs Network with public health agencies to secure an internship placement Types of Facilities and Experiences The internship allows students to utilize their training in an appropriate public health setting under the supervision of a qualified field supervisor. Assignments are made in collaboration with the facility, university and the student and are based on the student s specific field of study (i.e. track) to provide for a beneficial learning experience. Students have the opportunity to work in county health departments, school district health education programs, or non profit community based organizations. In addition, opportunities may be available in the health care delivery system including health maintenance organizations and Medical Centers. Students who plan to advance their education have elected to assume placements within the university environment as means to further develop their research and analytical skills. In each case, students are expected to engage in activities that contribute to their learning objectives while performing tasks related to the facility s needs. Typical field training activities may include (but are not limited to): MPH Internship Handbook Page 4

5 Developing, implementing and/or evaluating a health promotion programs for a specific population Conducting research on a public health issue of interest (e.g., study and instrument design; data collection, entry, and analysis, assessment of findings) Conducting policy analysis or advocacy related to a public health issue Conducting needs assessment of community/population s assets and challenges Coalition building and coordination of resources Development, pre testing and evaluation of curriculum and/or health education materials Contributing to the development of funding proposals Types of Learning Opportunities through the Internship The supervised field training experience will assist students in gaining practical skills and knowledge in theoretical preparation, needs assessment, planning, implementing and evaluating programs as well as in applied research. These experiences will give students an opportunity to apply academic course work in a real world setting, while preparing them for a career in public health. Students develop a poster presentation detailing their experience (CGH 306) and a final paper during their capstone course (CGH 307) which integrates their field experience with relevant coursework, providing evidence of their growth and achievement during their internship experience. The Internship Sequence 1. Determine eligibility, unit and hour requirement. Ideally, students complete their internship at the conclusion of all coursework. Students may elect to begin their internship requirements earlier, but must meet the following eligibility requirement: completion of all MPH core and concentration coursework. Students with previous public health employment may be eligible for a waiver of 200 hours. To submit a waiver request, students must possess a minimum of three years paid public health experience prior to admission to the MPH program. Waivers will be granted upon approval by a review panel. 2. Students arrange an individual appointment with the MPH Program Manager during the semester before they wish to complete the requirement. Prior to the meeting, students will submit a Student Interest Form and current resume. On this form, students will indicate their internship preferences and any agencies of interest. Students are encouraged to view the list of affiliated sites. During the meeting, students should come prepared to discuss career goals, areas of interest, professional strengths and weaknesses, skills to develop, preference for organization or agency, geographical location, educational needs and a time table for completing field training hours. Additional paperwork is completed at this time. The Program Manager will discuss strategies for researching and selecting sites. The Director will explain the specific requirements when the student registers for CGH The student begins researching and contacting potential internship sites and/or preceptors to discuss the potential for field training. Students may search for available placements in national and governmental organizations, local departments of health, community centers, and voluntary health organizations, to name a few. Students should submit a letter of interest to each site of interest and request an interview. Come prepared to discuss goals, objectives, possible projects, MPH Internship Handbook Page 5

6 timeframes and expectations during the interview. Students who desire to conduct their field training in a non affiliated agency must inform the Program Manager. If the site and field supervisor are suitable, appropriate forms will be forwarded to initiate the affiliation process. Once a site has been secured, and the appropriate forms have been signed, students may begin their field training hours. 4. Students attend an orientation during the first week of the semester in which they plan to begin their hours and register for the course. Registration consists of 4 units of field training (400 hours). Before beginning field training requirements however, students must attend an orientation session or set up an individual appointment with the Director if hours are to begin mid semester. 6. Students record work hours. Students may use a time card available on the MPH website to record their hours. Supervisors must confirm student hours. 7. Students keep a journal. Students completing the field training portion of the internship requirement will submit one reflective journal per each 100 hours worked. Specific requirements for the submission of journals are indicated in the course syllabus. 8. Students submit a learning contract. The student and field supervisor discuss the relative tasks to be accomplished during the internship. The student then develops a scope of work and identifies which of the MPH student competencies will be addressed though the experience. The Learning Agreement, a signed contract between the student, the agency and the MPH Internship Director, is submitted according to the following schedule: 400 hour practicum: prior to the completion of 100 hours 200 hour practicum: prior to the completion of 50 hours 9. Upon completion of field training hours, the field supervisor submits a performance evaluation to the Director. Field supervisors are encouraged to conduct an exit interview and shares their performance evaluations with the student for professional development purposes. 10. Students complete course requirements. Students will participate in a poster presentation that describes their field training experience. Guidelines for the poster presentation are articulated in the course syllabus. Students also submit an evaluation of their experience. Failing to meet all of the requirements within the semester will result in an IN for the course. The IN will be removed upon satisfactory submission of all required documentation and assignments. MPH Internship Handbook Page 6

7 The Fieldwork Facility Selection of Field Training Facilities CGU is open to new agencies participating in the program. Sites may have been referred by CGU staff/faculty or have contacted CGU directly. Local, national and international sites are welcome to apply. Requirements of the Field Training Facility Each agency participating in the program is required to submit an Agency Application to be a Field Placement Site form and sign the Internship Affiliation Agreement prior to student placement. Internships within the Claremont Consortium are not required to submit the Internship Affiliation Agreement but must submit the Agency Application to be a Field Placement Site form. New supervisors are encouraged to complete the agency application if even the site is already affiliated with the Claremont Colleges. Agencies selected to participate must agree to provide the following: A comprehensive range of public health experiences with exposure to diverse populations and systems; A setting where the student and field supervisor can work collaboratively to create a positive learning experience for the student and a valuable contribution to the facility; Appropriate space, equipment and resources for students to complete the required work; A qualified field supervisor who meets the criteria outlined below; and Completed forms agreeing to comply with the University policies and procedures. Facility Monitoring and Removal Only sites that offer satisfactory experiences for students will be retained. Agencies will be assessed regularly by evaluation forms submitted by student interns and site visits by the Director if necessary. Financial Compensation for Students Some agencies may offer a stipend. The possibility of monetary compensation will be negotiated directly with the student by the field supervisor. International students who plan to receive a stipend or any form of compensation must obtain permission for practical or academic training prior to beginning their fieldwork. Students should contact the Office of International Students to ensure that proper procedures are followed. Integration with Regular Employment Students may complete their field training hours within their current agency of employment. The student and field supervisor must create a description of a practicum experience that is above and beyond current job responsibilities. Efforts construed to be part of the normal work activities at the organization will not be awarded credit toward the requirement. This policy also covers students who elect to conduct their internships with faculty who supervise their research assistantships. MPH Internship Handbook Page 7

8 The Field Supervisor Selection and Role of Field Supervisor The workplace field supervisor is a professional experienced in developing, administering, and/or evaluating public health programs or policies. These individuals may have nominated themselves, been selected by the director of the agency, or be nominated by a CGU staff or faculty. Responsibilities of the Field supervisor Each field supervisor will meet with the student prior to the commencement of the field training experience. Both the student and field supervisor will develop a learning contract which illustrates clearly tasks to be completed by the intern. Students will work with the field supervisor to identify the MPH student learning objectives that correspond to those tasks and activities. Requirements of the field supervisor for the MPH student To supervise an MPH student the field supervisor should have a M.D., D.D.S., M.P.H., Ph.D. in Public Health or Dr.P.H. However, individuals who work in public health and have a related graduate degree (R.N., N.P., M.S.W., M.H.A., etc.) and/or the equivalent in terms of public health experience may be acceptable. The field supervisor must be available to: Provide guidance and advice to the student in the program area in which they will be located; Meet with the student in person, at a minimum, one hour per week; Keep in contact (in person or by phone, e mail, etc.) for the entire field work period, during the hours the students are in placement; Appoint another staff person to supervise the student when the field supervisor is not available; Complete all necessary forms in a timely manner; and Review policies and procedures with the MPH Internship Director either in person, during a site visit, or by the phone. Role of MPH Program Administration The MPH Program Director is responsible for the supervision and evaluation of student internships. The MPH Program Manager assists the students with the placement process. Both are available to counsel students about their field placement and to respond to inquiries from field supervisors. Should an incident arise that requires the student to change to a different field placement, the Director will assess the reasons for the relocation and provide written documentation to the supervisor. The MPH program administration provides guidance through the site selection and placement process. Part of the educational experience for the student is to research potential sites, network with public health agencies, and arrange meetings with potential site supervisors. MPH Internship Handbook Page 8

9 Description of Forms The following forms are located in the appendix and available electronically on the CGU MPH Program website. Forms to be completed by the Agency: Agency Application to be a Field Placement Site: completed prior to student placement. This form displays an inventory of activities in which students may participate and is filed in the MPH office. Please indicate if you do not wish to be contacted by students directly. Internship Affiliation Agreement: completed by the agency and signed by a designated staff member and the Provost at CGU. This form is completed prior to placing a student in a site. This form is not necessary for placements within CGU. Field Supervisor s Evaluation of Student: completed at the conclusion of the field placement. This form allows for a description of the students progress and rating of their overall performance. Supervisors are encouraged to discuss the evaluation with the student. Forms to be completed by the Student: Student Interest Form: completed prior to meeting with the Program Director. A current resume is attached. Waiver Criteria: provides instructions for completing the waiver request. Documentation is submitted to the Internship Director prior to beginning field training hours. Student Legal Agreement: outlines policies and procedures to be followed by students completing field training. This form is to be completed by the student and requires proof of health insurance. Student Release for International Travel: outlines policies and procedures to be followed by the student completing field training outside of the United States. This form is to be completed by the student before departure. Learning Contract: outlines the scope of work for the project to be completed by the student. This form is completed by the student with the assistance of the field supervisor at the beginning of the field experience and is approved by the Internship Director. This must be submitted prior to the attainment of 100 hours (400 hour practicum) or 50 hours (200 hour practicum). A draft scope of work should be e mailed to the Director in enough time to submit the learning agreement. Inventory of MPH Student Competencies: lists MPH core and concentration competencies. Students select general public health and concentration specific competencies that they seek to accomplish through the internship experience. This form is attached to the practicum learning agreement. MPH Internship Handbook Page 9

10 Time card: records hours worked during the field training experience. Students submit upon conclusion of the internship. Supervisors must confirm the hours worked. Academic Requirements of the Public Health Internship Core Classes and Concentrations Students enrolling in the Supervised Field Training course must be graduate students in the Master of Public Health Program. Typically, students take this course at the completion (or near completion) of all their courses. At a minimum, the student must have completed all MPH core and concentration courses. This ensures that students have knowledge of core public health concepts and basic skills in the area of emphasis. Students beginning their internship without approval by the Program Manager & Director will not receive credit for these hours towards the internship requirement. Time Commitment Exact hours and days worked will be negotiated between the student and the field supervisor. Since the summer semester is shorter (about 12 weeks), the hours spent in the field per week will be adjusted accordingly. Once registering for the course students have one year to complete field training hours and course requirements. Students will receive a grade of incomplete (IN) until all requirements have been met. Tracking Course Progress and Completion Course progress and completion will be tracked both from the field site supervisor and the MPH Internship Director. The field supervisor will contribute to the learning contract and the end of semester evaluation. Students are required to submit reflective journals of their work experience, a time card, evaluation and a poster presentation. Grading The Supervised Field Training course is graded as satisfactory/unsatisfactory. Students must satisfactory complete all requirements of the field training experience to receive credit for the course. Course syllabi indicate specific requirements for each component of the course. MPH Internship Handbook Page 10

11 APPENDIX

12 Claremont Graduate University Master of Public Health (MPH) Supervised Field Training in Public Health Spring 201 Summer 201 Fall 201 Today s date: AGENCY APPLICATION TO BE A FIELD PLACEMENT SITE (To be completed by the field supervisor) Agency and Division/Department/Program: Field Supervisor: Title of Supervisor: Academic Degrees Earned: Address: City: State: Zipcode: Phone: Fax: Agency Website: Professional specialty areas: How many MPH students can your accept at any one time? Anticipated start date for an intern: May prospective interns contact you directly? Yes/No Is your agency able to offer a stipend or other financial compensation for the student? Yes/No/Unsure If yes, provide an estimate of monetary or other form of compensation

13 Please RANK on a 1-5 scale (5 high) the learning opportunities available within your agency: Assessment Needs assessment of individuals or communities Determining program priorities Collecting/analyzing & managing data Analyses of social, cultural, historical context of problem Intervention Program planning/curriculum development Planning workshops, conferences Providing training/public speaking/presentations Setting program objectives Proposal writing/grantsmanship Marketing Community organizing Health communications Evaluation research Policy: Policy research Advocacy Interpreting regulations/programs from policy Process Skills Department, agency and community meetings Consultation Working with technology Working with diverse cultural and ethnic groups Working with interdisciplinary teams/ groups OTHER: In your estimation, which type of sub-specialty of public health would this experience best suit? Check all that apply. Health Promotion/Health Education Leadership & Management Biostatistics/Epidemiology Health Informatics

14 Please provide a brief description of the project/assignments in which you envision the student(s) being involved. Please list minimum qualifications (previous experience or skills, languages spoken) you require of a student for each position available. If available, please attach a job description. How would you categorize your agency? Please check all that apply. Health Department (state or district) Educational Institution Indian Health Service Other Government Entities (city, county) Hospital Community Clinic Community-based Organization Consulting Firm Social Services Agency Foundation/Research Institutions Union/Labor Organization Industry/Insurance HMO Private Voluntary Organization Military Tribal Agencies Ethnic Specific Target Population Urban Rural Other

15 If possible, please enclose the following materials, which will help to introduce your organization to students in the Masters of Public Health Program. A job description for any position similar to what the student may be doing A mission statement &/or written statement of objectives for your organization An organizational chart of your organization Brochures or pamphlets on your organization Brochures or pamphlets on your sponsored programs and/or services Information about your community. (e.g., local newspaper, maps, place of interest, etc). Please attach a copy of your resume (omitting home contact information) for our files review. Note: Supervisors must possess an advanced degree in public health or related field. Please return this form to: Darleen Peterson, PhD, MPH, MCHES Assistant Professor & Director MPH Program Claremont Graduate University 675 W. Foothill Blvd., Ste. 310 Claremont, CA Phone: (909) Fax: (909) darleen.peterson@cgu.edu

16 INTERNSHIP AFFILIATION AGREEMENT This INTERNSHIP AFFILIATION AGREEMENT ( Agreement ) is entered into on the day of, 20, by and between Claremont Graduate University, through its School of Community and Global Health (the "University"), and (the Facility ). Recitals A. An integral part of the University's Master of Public Health ("MPH") program is supervised field training experience with an approved facility for which students receive academic credit. B. The University desires the cooperation of Facility in implementing supervised field internship programs in public health at Facility s location and training University students in the practical applications of public health ( Internship Program ). C. Facility will benefit from the contributions of the University s students participating in the Internship Program. D. Facility wishes to assist the University in implementing an Internship Program; NOW, THEREFORE, in consideration of the mutual agreements set forth herein, the University and the Facility enter into this Agreement on the terms and conditions set forth below. The University s Rights and Responsibilities 1. To assign students to Facility who meet the University s requirements and qualifications to participate in the Internship Program. 2. To appoint a University faculty or staff member as Internship Director to administer the University s responsibilities related to the Internship Program and to oversee the students field experience at Facility. 3. To establish and maintain ongoing communication with the Field Supervisor, as defined below, regarding the Internship Program. 4. To notify the Field Supervisor, at a time mutually agreed upon, of the University s planned schedule of students assignments, including the names of the students, level of academic preparation, and length and dates of the internship experiences. 5. To inform students that they are to obtain and maintain adequate health insurance coverage during the time that students participate in the Internship Program and to provide evidence of such coverage to Facility, at Facility s reasonable request. 6. To ensure that all students participating in the Internship Program at Facility will be covered by professional liability insurance through the University s insurance coverage in the amounts set forth below.

17 7. To direct the assigned students to comply with the existing pertinent rules and regulations of Facility and all reasonable directions given by qualified Facility personnel. 8. To assume responsibility for providing grades to the students in connection with the Internship Program. 9. To inform Facility in the event that a student withdraws from the Internship Program or otherwise is unable to complete the Internship Program. Facility s Rights and Responsibilities 1. To provide one (1) qualified Facility supervisor ( Field Supervisor ) for each student enrolled in the Internship Program. A qualified field supervisor is determined by the MPH faculty supervisor and as outlined in the MPH Internship Handbook. Field supervisor responsibilities include the following: Meet with the student prior to the commencement of the field training experience; Orient the student to the Facility;. With the student, develop a scope of work which illustrates clearly tasks to be completed by the student; Assist the student in gaining access to information and data required for the project to be completed by student; Monitor student s attendance and meet with student in person, at a minimum, one hour per week;. Provide guidance and advice to the student in the program area in which they will be located;. Keep in contact (in person or by phone, etc.) for the entire field work period, during the hours the students are in placement;. Appoint another staff person to supervise the student when the Field Supervisor is not available;. Complete all necessary forms in a timely manner; Submit a final evaluation report of the student s performance;. Review policies and procedures with the Internship Director either in person, during a site visit, or by phone; and Any other responsibilities mutually agreed upon by the parties. 2. To complete an application for field placement students and to comply with the Field Internship Scope of Work. 3. To provide field experiences in accordance with the requirements of the University s curriculum. On-site visits will be arranged when feasible and/or upon request by the University. Facility shall advise the University of any changes in its personnel, operation or policies which may materially affect the students field experiences or the Internship Program at Facility 4. To ensure that students are given duties commensurate with their skills and experience.

18 5. To provide the physical facilities, resources and equipment necessary to operate the Internship Program at Facility, including use of library facilities, reasonable work and storage space. 6. To determine the number of students which it can accommodate during a given period of time and notify the University promptly prior to the commencement of the Internship Program. 7. To provide the assigned students with a copy of the Facility s existing pertinent rules and regulations with which the students are expected to comply. 8. To make available, whenever reasonably necessary, emergency health care for the assigned students, the cost of which shall be borne by the students. 9. To request the University to withdraw a student from the Internship Program at Facility when student s performance is unsatisfactory to Facility or student s behavior is disruptive to Facility or its clients. Facility shall state its reasons for requesting a student withdrawal in writing to the Internship Director. It is understood that except as set forth in paragraph 10 below, only the University can withdraw a student from the Internship Program at Facility. 10. To immediately remove from the Facility any student who poses an immediate threat or danger to personnel or the property of Facility. 11. To comply with all federal, state, and local laws and ordinances concerning the confidentiality of student records. 12. To comply with all federal, state, and local laws and ordinances concerning human subject research if students participate in a research program as part of a research team. 13. To maintain general liability and/or workers compensation insurance coverage acceptable to the University (with minimum coverage amounts as set forth below) to cover the Facility, its buildings, equipment and materials, its employees and agents, and any claims relating to actions or omissions taken by Facility s personnel. General Provisions 1. Non-discrimination. The parties shall make no distinction or discriminate in any way among students covered by this Agreement on the basis of race, color, sex (including pregnancy), religious creed, age, physical or mental disability, ancestry, sexual orientation, gender identity, marital status, national origin, or any other characteristic that is protected by law. 2. Coordination of Internship Program. The parties shall use reasonable efforts to establish the educational objectives for the Internship Program, devise methods for its

19 implementation and continually evaluate to determine the effectiveness of the field experience. 3. Students Not University Employees. The parties hereto agree that the University s students are fulfilling specific requirements for field experiences as part of a degree requirement and, therefore, the University s students are not to be considered employees or agents of either the University or the Facility for any purpose, including Workers' Compensation or employee benefit programs. 4. Insurance. Each party to this Agreement shall provide and maintain, at its own expense, a program of insurance or self-insurance covering its activities and operations hereunder. Such program of insurance or self-insurance shall include, but not be limited to, comprehensive general liability, professional liability and workers compensation. The general liability insurance shall have a minimum coverage of $300,000 per occurrence and cost $500,000 aggregate. The professional liability insurance shall carry a single limit coverage of not less than $1,000,000 per occurrence and $3,000,000 aggregate. Upon written request, either party shall provide the other with a certificate evidencing such coverage. 5. Term. This Agreement shall be effective for a period of one year when executed by both parties. This Agreement will be automatically renewed annually unless otherwise indicated in writing by one of the parties at least thirty (30) days prior to the end of the term, or unless terminated in accordance with paragraph 6 below. 6. Termination. This Agreement may be terminated by either party with or without cause upon ninety (90) days written notice, provided that all students currently enrolled in the Internship Program at Facility at the time of notice of termination shall be given the opportunity to complete the Internship Program at Facility. 7. Arbitration. All controversies, claims and disputes arising in connection with this Agreement shall be settled by mutual consultation between the parties in good faith as promptly as possible, but failing an amicable settlement shall be settled finally by arbitration in accordance with the provisions of this paragraph. Such arbitration shall be conducted in Los Angeles County, California, in accordance with the Commercial Arbitration Rules of the American Arbitration Association ( AAA ). The parties hereto hereby agree that the arbitration procedure provided for herein shall be the sole and exclusive method of resolving any and all of the aforesaid controversies, claims or disputes. The costs and expenses of the arbitration shall initially be shared equally by both parties, but ultimately will be determined by the arbitrator. The prevailing party in any arbitration will be entitled to recovery of all costs and attorneys fees expended in the arbitration. (a) Judicial Action. Legal action for (i) entry of judgment upon any arbitration award or (ii) adjudication of any controversy, claim or dispute arising from a breach or alleged breach of this paragraph 7 may be heard or tried only in the courts of the State of California for the County of Los Angeles or the Federal District Court for the Central District of California. Each of the parties hereto hereby waives any defense of lack of in personam jurisdiction of said

20 courts and agrees that service of process in such action may be made upon each of them by mailing it certified or registered mail to the other party at the address provided for in this Agreement. Both parties agree that the prevailing party in any such judicial action shall be entitled to recover from the nonprevailing party reasonable expenses, including without limitation, attorneys fees. 8. No Agency. Both parties acknowledge that they are independent contractors, and nothing contained herein shall be deemed to create an agency, joint venture, franchise or partnership relationship between the parties, and neither party shall so hold itself out. Neither party shall have the right to obligate or bind the other party in any manner whatsoever, and nothing contained in this Agreement shall give or is intended to give any right of any kind to third persons not signatory to this Agreement. 9. Assignment. Neither party hereto shall have the right, directly or indirectly, to assign, transfer, convey or encumber any of its rights or responsibilities under this Agreement without the prior written consent of the other party. Subject to the foregoing, this Agreement shall be binding upon and inure to the benefit of the respective successors and assigns of the University and Facility. 10. Governing Law. This Agreement shall be construed in accordance with and all disputes regarding this Agreement shall be governed by the laws of the State of California. 11. Severability. If any term or provision of this Agreement is for any reason held to be invalid, such invalidity shall not affect any other term or provision, and this Agreement shall be interpreted as if such term or provision had never been contained in this Agreement. 12. Notice. All notices to be given under this Agreement (which shall be in writing) shall be given at the respective addresses of the parties as set forth below, unless notification of a change of address is given in writing. Any notice required by this Agreement shall be deemed to have been properly received when delivered in person or when mailed by registered or certified first class mail, return receipt requested, or by Federal Express to the address as given below, or such addresses as may be designated from time to time during this term of this Agreement. Claremont Graduate University [Name of Facility ] School of Community and Global Health [Address 675 W Foothill Blvd., Suite 310 Claremont, CA ] [Phone ] 13. Authority to Sign. The parties signing below are authorized and empowered to execute this Agreement and bind the parties to the terms and conditions contained herein. 14. No Third Party Beneficiaries. This Agreement shall not create any rights, including without limitation third party beneficiary rights, in any person or entity not a party to this Agreement.

21 15. No Waiver. Any failure of a party to enforce that party s right under any provision of this Agreement shall not be construed or act as a waiver of that party s subsequent right to enforce any provisions contained herein. 16. Entire Agreement. This Agreement fully supersedes any and all prior agreements or understandings between the parties hereto or any of their respective affiliates with respect to the subject matter of this Agreement, and no change in, modification of, or addition, amendment or supplement to this Agreement shall be valid unless set forth in writing and signed and dated by both parties hereto subsequent to the execution of this Agreement. 17. Limitation of Liability. To the maximum extent permitted by law and excluding a breach of any term of this Agreement, in no event will either party be responsible to the other for any incidental damages, consequential damages, exemplary damages of any kind, lost goodwill, lost profits, lost business and/or any indirect economic damages whatsoever regardless of whether such damages arise from claims based upon contract, negligence, tort (including strict liability or other legal theory), and regardless of whether a party was advised or had reason to know of the possibility of incurring such damages in advance. Claremont Graduate University, On behalf of the School of Community and Global Health By: Kim Reynolds, PhD Associate Dean for Administration FACILITY By: [Name] [Title] Please return this agreement to: Darleen Peterson, PhD, MPH, MCHES Assistant Professor & Director MPH Program Claremont Graduate University 675 W. Foothill Blvd., Ste. 310 Claremont, CA Phone: (909) Fax: (909) darleen.peterson@cgu.edu

22 Claremont Graduate University Master of Public Health Program Supervised Field Training in Public Health FIELD SUPERVISOR S EVALUATION OF STUDENT This evaluation is designed primarily to provide feedback on job performance and related issues to assist the student in his/her academic, personal, and professional development. Please review and discuss your evaluation with the student. Thank you for taking the time to serve as a site supervisor. Your participation is valued by the student and the program. Student Name: Field Supervisor Name and Title: Name of Agency and Division or Department: Dates of Placement: Record your appraisal of the student s performance by writing the appropriate number in the blank after each item. For any items with a rating of 1 of 2, please provide an explanation in the space provided. Comments on any other items would also help the student are encouraged. Use N/A if there has been no opportunity to observe the skill, or if it is not relevant to the work setting. I. GENERAL JOB PERFORMANCE Beyond expectation Satisfactory Below expectation INTERPERSONAL SKILLS a. Ability to communicate with staff b. Ability to communicate with clientele c. Ability to work with and for others Rating Comments 2. SUPERVISION a. Ability to seek and use help b. Openness to constructive criticism c. Ability to work independently 3. PERSONAL QUALITIES a. Decision making

23 Beyond expectation Satisfactory Below expectation b. Trust and confidentiality c. Initiative d. Creativity e. Dependability f. Punctuality g. Professional appearance h. Ability and willingness to learn i. Adaptability j. Adherence to agency rules/norms Rating Comments 4. SKILLS a. Communication (verbal/written) b. Analyzing problems c. Problem solving d. Organization e. Follow-through f. Meeting deadlines 5. OVERALL STUDENT RATING a. Taking all items into consideration, how would you rate this student s performance at your agency? II. ACHIEVEMENT OF PROJECT OBJECTIVES In reviewing the project objectives outlined in the practicum contract (see scope of work), assess the extent to which you believe the student achieved these objectives. Discuss by what means you can determine whether each project objective was met. Please use a separate sheet of paper if necessary. 1. Project Objectives Met (Y/N) Measures of Success

24 III. ATTAINMENT OF MPH STUDENT COMPETENCIES In reviewing the MPH student competencies outlined in the practicum learning contract (see MPH competency inventory), assess the extent to which you believe the student mastered these competencies during their supervised field training experience. Discuss by what means you can determine these were achieved (i.e., measures of success). MPH Student Competency Level of Mastery** (C/SC/NC) Measures of Success a. General Public Health Competency (1) a. Concentration Specific Competencies (2) b. *Restate competencies selected in inventory **Choices include: C = Competent; SC=Somewhat Competent; NC= Not Competent

25 IV. STUDENT PROFESSIONAL GROWTH 1. Identify the areas of professional growth you have noticed in the student over the course of the internship? 2. What professional development plan would you recommend to the student (e.g., additional courses, skills or experience that would strengthen his/her career potential in public health)? 3. In your opinion, how well do prepared was the student to undertake the tasks asked of him/her during the course of the internship? Please make a section below and elaborate if appropriate. a. Very prepared b. Somewhat prepared c. Not very well prepared SUPERVISOR SIGNATURE DATE Please submit form to: Darleen Peterson, PhD, MPH, MCHES Assistant Professor & Director MPH Program Claremont Graduate University 675 W. Foothill Blvd., Ste. 310 Claremont, CA Phone: (909) Fax: (909) darleen.peterson@cgu.edu

26 Claremont Graduate University Master of Public Health Program Time Table for Completion of Supervised Field Training Forms and Requirements Form Completed by Deadline Practicum Interest Form Student Prior to meeting with Practicum Coordinator Agency Application 1 Agency Supervisor Prior to student beginning training hours Institutional Affiliation Agency Designee Prior to student beginning training hours Agreement 2 Waiver Criteria Student Prior to student beginning training hours Student Legal Form Student Prior to student beginning training hours Release for Domestic or International Travel and/or Travel Information Form Time Card Learning Contract (includes scope of work 3 and student competency inventory) Student Student; approved by Agency Supervisor Student; approved by Agency Supervisor and Practicum Coordinator Prior to student beginning training hours Submitted and approved electronically Prior to student attainment of 100 hours of a 400 hour practicum and 50 hours of a 200 hour practicum Reflective Journals Student One journal at the attainment of 100 hours (4 journals for a 400-hour practicum and 2 journals for a 200-hour practicum) Final Paper Student At conclusion of field training hours (see syllabus for due dates) Student Evaluation of Field Training Experience Field Supervisor s Evaluation of Student Student Agency Supervisor conclusion of field training hours (see syllabus for due dates) At the conclusion of field training hours 1 Needed only if agency is not currently listed on list of MPH affiliated sites OR supervisor is new 2 Needed only if agency is not currently listed on list of MPH affiliated sites 3 A draft scope of work must be uploaded BEFORE submitting the final learning contract.

27 Claremont Graduate University MPH SUPERVISED FIELD TRAINING INTEREST FORM Your answers to the following questions will assist the MPH Program Director in better meeting your needs as an intern. Please submit this form in the semester prior to beginning your practicum. Attach a current resume with this form. Today s Date: Name & ID Number: Address: Phone#: Concentration: Is a stipend essential? Citizenship: Do you speak, read or write other languages? List courses completed, in-progress, and planned. Course Semester Completed, in-progress or planned Indicate your preferred schedule concerning your field training. Begin field training hours Register for field training requirement Fall 201_ Spr 201_ Sum 201_ Unsure

28 Are you eligible to apply for a waiver? (See practicum manual for eligibility criteria.) Describe your educational background. List degrees and/ or certifications you hold. Describe your prior work/volunteer experience that might be applicable to a practicum placement. Indicate your short term (6 months 1 year) and long-term (up to 5 years) career goals. Indicate your primary interest in areas of public health practice. a) Desired populations children teens adults seniors cultural and/or ethnic groups (please specify) b) Agency setting county/state/govt. private non-profit education other (please specify) c) Specific issues in public health you desire to work in (Please specify below):

29 Please RANK on a 1-5 scale (5=high) the experiences you seek within your placement. ASSESSMENT INTERVENTION PLANNING POLICY PROCESS OTHER Ranking Needs assessment Determining program priorities Data collection / analysis Analyses of social, cultural, historical context of problems Program planning /development Planning workshops, educational programs Setting program objectives Proposal writing/grantsmanship Marketing and outreach Community Organizing Health communications & program materials Program Evaluation Policy Research Advocacy Interpreting regulations/programs from policy Department, agency and community partnerhips Consultation Computer proficiency Working with diverse cultural and ethnic groups Working with interdisciplinary teams/groups List any agencies to which you have selected to apply or which you are thinking of applying. Have you made contact with any of these sites? If so, which ones and with whom? Describe any special concerns/circumstances or limitations you may have that may affect your field training experience (e.g., transportation, geographic location, limited working hours, etc.).

30 Claremont Graduate University MPH Program Supervised Field Training in Public Health WAIVER CRITERIA Description A supervised field training experience is required of all students in the MPH program. Students are required to complete field training hours (400 hours) and fulfill accompanying course requirements. Certain students may be eligible for a waiver of the hour requirement. Requests for a partial waiver of hours are considered and approved on an individual basis. The procedures for requesting a waiver are provided below. Wavier Eligibility Criteria Students with previous public health employment may be eligible for a partial waiver of hours. Applications will only be considered if a student can verify three years of continuous, paid, public health employment prior to enrollment in the MPH program. Students receiving a waiver due to previous public health experience complete 200 hours of field training. Public health work involves organized community-based efforts. Clinical experience involving individual patient care or health facility administration is not considered relevant public health experience. Relevant public health experience must include involvement in at least one of the following activities: Assessing, monitoring, or conducting surveillance of health conditions or delivery of services in a population; Establishing public health objectives and priorities; Conducting basic or applied research on population-based health problems including the behavioral, biological or environmental risk factors; or Designing, implementing and/or evaluating policies and/or intervention strategies/programs. Waiver Instructions Students shall submit a 2-3 page (single-spaced) narrative describing relevant public health work experience, including all the following sections: Description of specific duties performed; Discussion of the impact or relevance of the experience to public health, highlighting knowledge, theories and concepts covered in MPH coursework; Identification of competencies gained in the previous work experience (see MPH general and concentration specific competencies specified in the MPH Learning Outcome Inventory); and Reference/contact person (preferably someone who supervised you) so that employment/involvement with the agency can be verified. Incomplete narratives will not be reviewed. Waivers should be submitted electronically to the MPH Program Director at least 1 month prior to registration in CGH 306. Please remit to: Darleen Peterson, PhD, MPH, MCHES, Phone: (909) , Fax: (909) , darleen.peterson@cgu.edu. Waiver Decisions Once received, a review committee will assess the relevance of the previous work experience. Students will be contacted by the MPH Program Director within two to three weeks with a decision. Decisions of the panel are final. A letter confirming a waiver of hours will be sent to the student.