BHSU Library Media Practicum Proposal / Agreement (Spring Semester, 2016)
(Complete via MS Word; or, in pen as hardcopy)
Student Contact Information
Name, Last / Name, First / Name, MiddlePhone, Local / Phone, Cell / Phone, Work
Email, University / Email (Other – if used routinely) / Email (Other – if used routinely)
Address, Street / City / State & Zip
In-Case-of-Emergency Contact
Name: / Relation: / Phone, Work:
Phone, Home:
Student Survey (in MS Word, underline your response; or, circle it, if done in hardcopy)
Are you currently a licensed teacher? Yes No
Are you currently employed as a school librarian? Yes No
When do you intend to complete the LIBM program? 2016 2017
How many credits of the LIBM program have you already completed? 4-10 10+
Are you a non-education student (in the College of Business, Liberal Arts, etc.) Yes No
Do you have more than 1 year experience in a paid position as a school librarian? Yes No
Are you now working, or have you previously worked, for this Practicum site library? Yes No
Student Practicum Responsibilities
· Fulfill the duties and responsibilities outlined in the Practicum forms and logs.
· Upload to D2L -in a timely fashion- all completed Practicum forms, logs, and surveys.
· Locate an appropriate library, then complete and sign the Proposal Agreement (this form).
· Provide your Practicum Mentor with a signed copy of the Proposal Agreement (this form).
· Maintain a weekly log listing specific objectives, tasks, issues, etc., encountered in the field.
· Insure that the 90-hour Practicum workload was covered with your Mentor, at the site library.
· Complete a Practicum assessment, delivering it directly to your Instructor (not Mentor) via D2L.
· Treat the Practicum as a professional job; represent BHSU in a professional manner at all times.
· Send your Mentor a “thank-you” letter and upload to the D2L dropbox a copy of this document.
· Read and understand the Endorsement application process (a D2L file; education students only).
Mentor Contact Information
Name, Last / Name, First / TitleTelephone / Email / Supervisor’s Name & Title
Name (Institution) / Address (Institution) / Telephone (Institution)
Mentor Survey (in MS Word, underline your response; or, circle it, if done in hardcopy)
Is this proposed Practicum (fieldwork) a paid position? Yes No
Has this student previously worked for this organization? Yes No
Have you previously worked with this student in any capacity? Yes No
Have you previously supervised other BHSU fieldwork students? Yes No
Will you be supervising more than 1 fieldwork student this semester? Yes No
Do you have control/oversight (daily, or at District level) of the proposed site library? Yes No
As proposed, would the Library Practicum be considered full-time (30+ hours, weekly)? Yes No
Mentor Practicum Responsibilities
· Complete the middle portion of the Practicum Agreement form (this form).
· Provide liability insurance and workmen’s compensation coverage for the student.
· Review, if required, the student’s weekly log forms for completeness and accuracy.
· Complete the Student’s final assessment form and email it directly to the Instructor.
· Train and supervise the student for the duration of the 90-hour fieldwork experience.
· Allow the student to experience a variety of library tasks, assignments, instruction, etc.
· Converse with the Practicum instructor, if necessary, to discuss the student’s performance.
· Offer insights, if need be, into the strengths and/or weaknesses of the BHSU’s LIBM program.
Practicum Proposal / Description / Agreement
(List specific duties, assignments, tasks, teaching, etc. making up the core of the 90-hour fieldwork)
(Note: If this fieldwork utilizes a job description, please attach a copy of this document in lieu of filling out this section)
Practicum Agreement
______agrees to participate in
(Name of organization)
the Black Hills State University Library Media Program by accepting
______as an intern
(Name of Student)
from ______to ______.
(Beginning month/day/year) (Ending month/day/year)
Signatures (Mentor & Student, per the above outlined, Black Hills State University, School of Education, Library Media Practicum)
______
(Student intern’s signature) (Date) (Mentor’s signature) (Date)
THANK YOU FOR YOUR WILLINGNESS TO SERVE AS A BHSU INTERNSHIP PARTNER!
The Mission of the School of Education is to prepare
competent, confident, and caring professionals.