MMC Practicum - Student Agreement and Responsibilities

JOUR 777: Master’s in Mass Communication Student Practicum Agreement and Responsibilities Statement
Congratulations on securing your practicum! We are excited to learn more about your experience and guide you through the JOUR 777 course.

Please complete the information below as your first assignment in the course.

In addition to submitting this form, provide the Jotform to your supervisor (Agreement and Responsibilities statement) to be completed during the first week of class. They can sign the document electronically.
Student Name:*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email Address:*
example@example.com
Home Phone Number

Area CodePhone Number
Cell Phone Number:*

Area CodePhone Number
Supervisor's Name:*

First NameLast Name
Supervisor's Title:*
Organization Name:*
Organization Physical Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Phone Number:*

Area CodePhone Number
Practicum Starting Date:*

MonthDayYear
Practicum End Date:*

MonthDayYear
How many hours do you plan to complete at your practicum location? (Must complete at least 300 hours to be eligible for the JOUR 777 course):*
Proposed Work Schedule (approximately 20 hours a week, 300 hours total for the semester) - please enter "0" if not working on selected day*
Please list your job description (bulleted list of your practicum duties) below. Please coordinate with your supervisor to gather this information.*
The following criteria are required of all students enrolled in the JOUR 777 course:
- Work at least 300 hours by the end of the semester at the practicum organization
- Turn in the following assignments as scheduled in the course syllabus:
  - Student Agreements and Responsibilities Statement
  - Supervisor Agreement and Responsibilities Statement
  - Student Midterm Progress Report
  - Supervisor Midterm Progress Report
  - Student Final Evaluation
  - Supervisor Final Evaluation
  - Final Paper
- Note: All course assignments and the 300 hours of work must be completed by the last day of class.
I understand*

By submitting this online form, I acknowledge and agree the aforementioned information. the practicum student named below acknowledges that the supervising organization named above is under no obligation to offer said practicum student a paid position following completion of the practicum.
Signature*
First and Last Name
Questions?

Please reach out to the practicum (JOUR 777) instructor, Professor Jacqueline Keisler, at keislejm@mailbox.sc.edu or (803) 777-3321.
Should be Empty:

JOUR 777: Master’s in Mass Communication Student Practicum Agreement and Responsibilities Statement