Agency Profile
Required form submitted by agencies as part of site approval process. (Must be completed prior to placement of student).

Download agency_profile.pdf. (requires Adobe Acrobat Reader to view)
Download agency_profile.doc. (requires Microsoft Word to view)

University Agency Agreement
Required agreement between the agency and CSU Monterey Bay, completed by the agency as part of the site approval process. (Must be completed prior to placement of student/s).

Download UAAPS.pdf. (requires Adobe Acrobat Reader to view)

Field Learning Agreement and Student Assessment
The purpose of the Field Learning Agreement and Student Assessment (FLASA) is to provide a framework for planning the student's field practice experiences in the agency as well as evaluating the student's competence in selected MLOs prior to and after their placement. This plan will provide guidance and support for the student's efforts to improve their level of competence with agency needs and opportunities.

Download FLASA_coversheet for Juniors (PDF document - requires Adobe Acrobat Reader to view)
Download FLASA_coversheet for Juniors (Word Document requires Microsoft Word to view)

Download FLASA_coversheet for Seniors (PDF document - requires Adobe Acrobat Reader to view)
Download FLASA_coversheet for Seniors (Word Document requires Microsoft Word to view)

Download timesheet.pdf. (requires Adobe Acrobat Reader to view)
Download timesheet.xls. (requires Microsoft Excel to view)

The following assessment forms are tied to the Major Learning Outcomes on the student's Field Learning Agreement. Use the drop down menu to select the correct form in either pdf or Excel format.

Mid Year Student Evaluation
This evaluation will be completed by the Field Mentor at the mid-point of each two semster placement to document the student's progress and indicate areas of focus for the remaining placement period.

Download MidYearEvaluation (PDF document - requires Adobe Acrobat Reader to view)
Download MidYearEvaluation (Word document - requires Microsoft Word to view)

Student Site Evaluation
This evaluation will be completed by the student at the end of each placement. This is the student's opportunity to give feedback on their field placement site and Field Mentor to HHSPP. Students should include what learning opportunities were available for selected MLO's and whether or not they recommend this as a future field placement site for other students.

Download student_site_evaluation.pdf. (requires Adobe Acrobat Reader to view)
Download student_site_evaluation.doc. (requires Microsoft Word to view)

Mentor Evaluation of Field Practice Program
This form is completed by the agency Field Mentor at the conclusion of the student's placement.

Download Mentor Evaluation of FPP.pdf. (requires Adobe Acrobat Reader to view)
Download Mentor Evaluation of FPP.doc.(requires Microsoft Word to view)

Required Service Learning Forms
These forms are due as indicated in the CHHS calendar and must be submitted electronically by students.