Student Information:
  • Name: [Your Full Name]
  • Student ID (D#): [Your Student ID]
  • Email: [Your Email Address]
  • Phone Number: [Your Phone Number]
Mentor Information:
  • Name and Credentials: [Mentor’s Full Name and Credentials]
  • Contact Information:
    • Work Phone: [Mentor’s Work Phone Number]
    • Cell Phone: [Mentor’s Cell Phone Number]
    • Email: [Mentor’s Email Address]
    • Work Address: [Mentor’s Work Address]

Directions:

  • Week 1: Initial Planning
    • Self-Identified Goals: In Week 1, identify your goals that align with the course outcomes. These goals should reflect what you aim to achieve during your practicum experience.
    • Initial Plans: Develop a strategy for how you plan to achieve these goals. Review your goals and plans with your mentor for feedback and make any necessary adjustments.
  • Weekly Revisions:
    • Ongoing Updates: Revisit and revise the learning agreement weekly. Update completed goals, add new goals if needed, and adjust your plans based on actual experiences or feedback from your faculty or mentor.
  • Week 6: Final Evaluation
    • Evaluation of Success: In Week 6, assess the success of your goals with your mentor. This evaluation should reflect on what you accomplished and any areas for improvement.
    • Mentor’s Signature: Obtain your mentor’s signature to confirm the completion and evaluation of your learning experience.
  • Submission Details:
    • Initial Submission: Submit your completed Learning Agreement with your self-identified goals and plans by the end of Week 1.
    • Final Submission: Submit the revised and completed Learning Agreement with evaluations by the end of Week 6.
  • Grading: Your Learning Agreement will be graded based on the Learning Agreement Grading Rubric. Feedback and grades will be provided after submissions in Week 1 and Week 6.

Sections of the Learning Agreement:

  1. Goals and Plans:
    • Goal 1: [State your first goal]
      • Plan: [Describe how you will achieve this goal]
    • Goal 2: [State your second goal]
      • Plan: [Describe how you will achieve this goal]
    • (Continue for additional goals)
  2. Weekly Updates:
    • Week 1: [Describe progress and any changes made]
    • Week 2: [Describe progress and any changes made]
    • (Continue for each subsequent week)
  3. Final Evaluation:
    • Evaluation Summary: [Summarize the overall success in achieving your goals]
    • Mentor’s Feedback: [Include any feedback from your mentor]
    • Mentor’s Signature: ____________________________
    • Date: ____________________________