Clinical Practicum Forms

Documentation is required for all students engaged in clinical training. Timely and accurate completion of the following practicum-related forms for each undertaken practicum is a program requirement and the responsibility ultimately rests on the student to ensure deadlines are met.

  • All documentation must be received in the form of a soft copy on, or before, the document deadline
  • Forms are to be sent electronically to
  • The student is responsible for obtaining all required signatures (digital, wet, and/or e-signatures are all accepted)
  • Forms should always be downloaded from the website to ensure the correct form versions are being used; older versions will not be accepted
Form Deadline Responsibility for Document Submission
WSIB Student Declaration Start Date (1 Form/Degree) Student
COVID_Insurance Addendum Start Date Student
WSIB Employer Declaration 1 month from Start Date Student
Clinical Placement Learning Contract* End of the second week of September (except for the summer practicum and other off-cycle placements**) Student
Clinical Placement Student Evaluation (x2)

Placement Mid-Point Eval: As specified in the Learning Contract

Final Placement Eval: May 1st for placements that start in September and September 1st for summer placements.

Clinical Supervisor(s)
Clinical Placement Clinical Hours Summary 2 wks after End Date Student
Clinical Placement Feedback (internal use only) 2 wks after End Date Student

*For a practicum extension, a revised learning contract must be submitted at least one month prior to the original end date.

**For the MA summer practicum (and any other clinical practica not starting in the month of September), the deadline for the Clinical Placement Learning Contract will be 2 weeks from the placement start date.

Note for Mac Users:

Default settings on a MAC generally open Adobe Acrobat PDF files in “Preview” mode, which does not display or print the encrypted personalized data on your forms properly. You should:

  • Open the PDF document using the “Open With” option and select “Acrobat Reader”.
  • Save the document using the “Save File” option and open the file directly from the Adobe Acrobat Reader program

Program Sanctioned Hours

From time to time, the program may sanction certain clinical activities that are outside of the standard practicum experience. Before initiating these clinical activities, students must complete a Program Sanctioned Hours Approval Form, which must be approved by the Program Coordinator and the student's academic supervisor(s). Students should familiarize themselves with the GD-PCS Policy and Procedures on Program Sanctioned Hours, which outlines the criteria and process in full detail.