ࡱ> /1.y bjbj 7{{||~f"""""$##""8 ""="0qUN0~],VvVV`##(~V| : University of Memphis Department of Social Work Field Education PROBLEM IN FIELD FORM This form must be used to document problems in field. Students and field instructors are asked to discuss problems and attempt resolutions as part of the supervisory process. Following discussions in supervision, the next step to resolution of an issue is to involve the faculty liaison. A conference will be scheduled with the student, faculty liaison and field instructor. This form will be completed by the faculty liaison and must document the plan for resolution of the problem in field. At any time the parties may consult with the director of Field Education. Date of Meeting: __________________________ Student: _________________________________________ Agency Placement: _____________________________________________ Field Instructor: ___________________________ Phone: ______________________________________ Faculty Liaison: ____________________________________________ 1. State the problem: 2. List of activities to resolve the problem: 3. Issues still to be addressed: 4. Clearly state the expectations upon which all parties agree that will take place to Address the unresolved problem(s). Expectation Person Responsible Completion Date 5. Plan to address future concerns: All parties in attendance should review and sign this agreement. Any additional comments may be written and attached to this form. Comments Attached? Student: _______________________________________________ Date: __________ Yes ___ No ___ Field Instructor: ______________________________________ Date: __________ Yes ___ No ___ Faculty Liaison: _______________________________________ Date: __________ Yes ___ No ___ Director of Field: ______________________________________ Date: __________ Yes ___ No ___ Rev 5/09 0@ABXYZ      G v . ϽޭtgtgtggZgZgMh{hOJQJ^Jh{h{OJQJ^Jh{h8ZOJQJ^Jh{h(OJQJ^Jh{hOJQJ^Jh{h@OJQJ^J#h{h@5CJOJQJ^JaJh{h5CJOJQJaJ#h{hC5CJOJQJ^JaJh5CJOJQJ^JaJ#h{h5CJOJQJ^JaJhC5CJOJQJ^JaJ0ABXYZ  P Q   G H $a$gd(gd{gd8Zgd@$a$gd  / 0 1 2 S T U V W X Y        B C 0^`0gdsY8^8gdsYgd@. / 0 1 2 S U V W         A B F 1EFIJŸŝœœxkxaxWxWxWxWxWhdOJQJ^JhsYOJQJ^Jh{h=OJQJ^Jh{hsYOJQJ^Jh{h>*OJQJ^JhjXOJQJ^Jh{h@>*OJQJ^Jh{hOJQJ^Jh{h +kOJQJ^Jh{h@OJQJ^Jh{h{OJQJ^Jh{h {OJQJ^Jh{OJQJ^Jh@OJQJ^J!C D E F [\'(]gd {]gdsYgdsY 0^`0gdsY3`abcy{ȷ h{hsYCJOJQJ^JaJh{h {OJQJ^JhsYOJQJ^JhdOJQJ^Jh{hsYOJQJ^Jh`%OJQJ^J51h0:p= /!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] .   C  8@0(  B S  ?AB0@ARabc0@A1 Xu76h ^`hH.h pp^p`hH.h @ L@ ^@ `LhH.h ^`hH.h ^`hH.h L^`LhH.h ^`hH.h PP^P`hH.h  L ^ `LhH.1 Xu          `%jXsY8Z +kDq {@Cd={(DW;@AAAA@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial7@Cambria5. .[`)TahomaA$BCambria Math"hՒ GՒ G&!u !u !r4 3QHX ?@2!xx PROBLEM IN FIELD FORMRhode Island College"Susan Elizabeth Elswick (selswick) Oh+'0  0 < H T`hpxPROBLEM IN FIELD FORMRhode Island CollegeNormal$Susan Elizabeth Elswick (selswick)2Microsoft Office Word@@ L@~@~!u՜.+,0 hp  Rhode Island College  PROBLEM IN FIELD FORM Title  !"#$%'()*+,-0Root Entry Fi|21TablefWordDocument7SummaryInformation(DocumentSummaryInformation8&CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q