Fillable ESP Exception Form

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ESP Exception Form

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For more information about Employment Situated Practicums, see the Field Practicum Manual on the School
of Social Work Website - www.wichita.edu/socialwork/practicum/manual.
Revised 2/2015
Employment Situated Practicum (ESP)
Exceptions Form
Date:
Student:
Agency:
Student Phone:
Student Email:
Field Instructor Name:
Field Instructor’s Email:
Field Instructor’s Phone:
On-Site Supervisor’s Name:
On-Site Supervisor’s Email:
On-Site Supervisor’s Phone:
Describe how your practicum duties will be new learning and differ from your current paid responsibilities:
Student Signature
Date
Field Instructor Signature
Date
On-Site Supervisor Signature
(When Applicable) Date
Director of Field Practicum Signature
Date
Employee Administrator’s Signature
Date
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ESP Exception Form

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Completed 16 February 2020

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