Industry Practicum (BIO300) Application
Please type or write in black ink to assist with photocopying
NB. This is NOT an enrolment form
PERSONAL DETAILS
Given Name and Surname
Student Number
Address
Postcode:
Telephone (work)
Telephone (home)
E-Mail
COMPANY DETAILS
Company Name
Company Address
Postcode:
Telephone
Fax
E-Mail
CONTRACT DETAILS
Course in which you are enrolled
Points value:
Name of Academic Supervisor (must be a full-time or fractional full-time
Murdoch University academic staff member)
Title
Name
School
Company Supervisor
Title
Name
Positionk
Address
(if different
to above)
Start
Date
Finish
Date
Semester
Option
Most practicums are taken over one semester. However, a practicum need not be rigidly tied to a 13 week semester pattern; you can start your
contract earlier or take it over two semesters. All practicums must finish by the dates shown above, unless deferred assessment is approved.
Project
Title
This will appear on your academic transcript FOREVER, so cannot exceed 50 characters (including spaces between words). It should be a specific
and informative so that employers and others who sight your transcript will know both your topic and the discipline involved. As for as possible try
to use words that would be readily understood by a person not fully acquainted with the area of study. Leave out redundant words such as “A study
of”.
OUTLINE OF YOUR INDUSTRY PRACTICUM
(to be completed by student)
1 Outline of work to be undertaken for this practicum (Please attach this as a separate sheet)
(Must be sufficiently detailed to allow assessment of academic merit. Attach extra pages if necessary)
2 What background do you have in the area of the practicum
(Include ISCs, previous work experience, relevant courses give details, for ISC ‘s include title, supervisor and final grade)
3 Expected activities
(If your practicum involves work with human subjects or animals, you should discuss with your supervisors and potential
ethical difficulties and how these are to be addressed)
library research field work laboratory experiments
interviews data collections writing
other (eg surveys - please give details)
4 What are your specific learning objectives (skills and training you hope to obtain during
this contract)
(Refer to the knowledge, attitudes, skills or abilities you wish to develop during this practicum. Give a clear, concise
statement, preferably in point form, of the objectives or aims of the practicum. The objectives will depend on the purpose of
the practicum, what is to be learned, and whether or not the practicum leads to more advanced studies.)
5 Details of reports and other items to be prepared for assessment of this practicum
ASESSMENT DETAILS
Due Date
% Mark
Company Supervisor’s Report
10%
I agree to fulfil the contract as
fully specified above
Signature
Date
SUPERVISOR DETAILS
ACADEMIC SUPERVISOR
1 Do you consider this project to be appropriate for an Industry Practicum?
2 Please comment on the student’s capacity to undertake the contract and your assessment of the
quality of the practicum. It is recommended that you check the applicant’s academic record.
3 Any other comments:
I am willing to act as Academic
Supervisor
Signature
Date
COMPANY SUPERVISOR
1 Are there any confidentiality restrictions on publication of the
results of this contract, or any other
confidentiality considerations?
yes no
(If YES, a copy of the confidentiality agreement can be obtained from the Industry Practicum Co-ordinator and should be signed by
the student, academic supervisor(s) and a company representative and returned to the Industry Practicum Co-ordinator. If you wish
to discuss this first, please contact the Industry Practicum Co-ordinator.
2 Any other comments:
I am willing to act as Company
Supervisor
Signature
Date
Industry Practicum Co-ordinator
Does this practicum comply with University policy?
The academic supervisor is a full-time or fractional full time member of Murdoch staff.
It is based primarily on independent and individualised study.
The points value is as specified on the front page of this form.
The student is enrolled for a Murdoch University degree or diploma. (Industry Practicums are not available for
NFD and cross-enrolling students).
The student has a good academic record.
The student is not a Part I student.
The assessment methods comply with University expectations for an Industry Practicum and with the requirement
for more than one piece of work.
Confidentiality and intellectual property arrangements are satisfactory.
I have checked that the application has been completed fully, and clarified any omissions or ambiguities.
Industry Practicum Coordinator
Signature
Date
ENTERED INTO DATABASE : / /
COPY SENT TO:
/ / Student
/ / School Executive Officer
/ / Company Supervisor
/ / Academic Supervisor
/ / File
Date received by Student
Administration
Code
Enrolment Option
Data Entry: Date
Initial
INDUSTRY PRACTICUM CO-ORDINATOR:
Associate Professor Mike Calver
School of Veterinary and Life Sciences
Murdoch University
Murdoch, WA 6150
AUSTRALIA
Tel: +61 8 9360 2277 Fax: +61 8 9360 6303 Email: m.calver@murdoch.edu.au
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