Students in Paid Practicum Placements

Students in PAID Practicum Placements are required to confirm the declaration of understanding as well as reviewing the Brock University Human Resources – Health, Safety and Wellness website.

From that site, you are required to submit:

  • Pre-Placement Field Trip Due Diligence Checklist (2 pages) – TO BE SIGNED BY A REPRESENTATIVE OF THE PLACEMENT EMPLOYER, not the student;

PDF UPLOAD ONLY (max 9.6Mb)
Errors in uploading are generally related to file size. Please double check the quality and image settings of the scanner – higher quality and colour scanning increases file size dramatically.

Paid Practicum Placements

Student receives wages from their placement employer and are treated as any other worker employed by the placement employer. Student has an employee contract with their employer that outlines the responsibilities of the employer and the student/employee. The student also requires a practicum agreement that outlines practicum site/supervisor and practicum student responsibilities in addition to the employer/employee contract. 

If you require additional information about whether you qualify as a paid or unpaid practicum student, please contact Dr. Julie Koudys, Clinical Coordinator at jkoudys@brocku.ca.

Additional forms will be required both during and at the end of the practicum course(s). Information about these forms will be provided by your course instructors.

  • Name * Required
  • BCBA Supervisor Name * Required
  • Agency Address * Required
  • Accepted file types: pdf.
    TO BE SIGNED BY A REPRESENTATIVE OF THE PLACEMENT EMPLOYER, not the student. If your placement is both paid/unpaid > only 1 copy of this form is required.
  • If any safety concerns were identified during completion of the Pre-Placement Field Trip Due Diligence Checklist students are asked to briefly describe the concerns and to directly contact the Clinical Coordinator, Dr. Julie Koudys, jkoudys@brocku.ca in a timely fashion.
  • Declaration * Required
    By clicking above, I declare and I understand that I am a paid practicum student and as such I am not covered through MAESD or by Brock University for liability insurance or the WSIB. In participating in a paid placement, I will be covered either through private insurance or by WSIB through my paid practicum placement. If this is "both" additional unpaid forms will need to be submitted.
  • This field is for validation purposes and should be left unchanged.