ࡱ> FIEy *)bjbj 72{{||T> fZJuceeeeee$ 8#Q!!!!c!cp ׻7 O0 ,#Ap##l!!!!!!!d!!! !!!!#!!!!!!!!!| : 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:  FORMTEXT       Student:  FORMTEXT       Agency Placement:  FORMTEXT       Field Instructor:  FORMTEXT      Phone:  FORMTEXT       Faculty Liaison:  FORMTEXT       1. State the problem: FORMTEXT       2. List of activities to resolve the problem: FORMTEXT       3. Issues still to be addressed: FORMTEXT       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  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       5. Plan to address future concerns: FORMTEXT       Al0@ABXYZZ \ ` b v x z Ͻޭvl[vGv:vlh{hOJQJ^J&jhi*OJQJU^JmHnHu!jhi*OJQJU^Jhi*OJQJ^Jjhi*OJQJU^JhAyOJQJ^Jh{h@OJQJ^J#h{h@5CJOJQJ^JaJh{h5CJOJQJaJ#h{hC5CJOJQJ^JaJh5CJOJQJ^JaJ#h{h5CJOJQJ^JaJhC5CJOJQJ^JaJ0ABXYZ  6 8  B D F H $a$gd(gd{gd8Zgd@$a$gd      D F Z \ ^ h j x z ࿲ॲyl[l!jhi*OJQJU^Jh{h{OJQJ^J!j\hi*OJQJU^J!jhi*OJQJU^Jhi*OJQJ^Jh{hOJQJ^Jh{h8ZOJQJ^Jh{h(OJQJ^J&jhi*OJQJU^JmHnHujhi*OJQJU^J!jthi*OJQJU^J"   0 2 4 > @ ࿲}lbXKh{h {OJQJ^Jh{OJQJ^Jh@OJQJ^J!j,hi*OJQJU^J!jhi*OJQJU^Jhi*OJQJ^Jh{h@OJQJ^Jh{hOJQJ^Jh{hOJQJ^Jh{h8ZOJQJ^J&jhi*OJQJU^JmHnHujhi*OJQJU^J!jDhi*OJQJU^JH J L N >@BDFHJBXVXrtvx8^8gdsYgd@ ,.0:<>BDFZpxzνة朏wwiiXة!jhi*OJQJU^Jh{h>*OJQJ^JhjXOJQJ^Jh{h@>*OJQJ^Jh{hOJQJ^Jh{h +kOJQJ^J&jhi*OJQJU^JmHnHu!jhi*OJQJU^Jhi*OJQJ^Jjhi*OJQJU^Jh{h@OJQJ^Jh{h{OJQJ^J .0DFHRTVXZnpr|~±–…tc!jhi*OJQJU^J!jbhi*OJQJU^J!jhi*OJQJU^J!jvhi*OJQJU^JhsYOJQJ^J!jhi*OJQJU^Jhi*OJQJ^J&jhi*OJQJU^JmHnHujhi*OJQJU^J!jhi*OJQJU^J&  ,.0:<JL`bdnprxzԲޥzpcYԥch{OJQJ^Jh{h{OJQJ^JhsYOJQJ^J!j:hi*OJQJU^Jh{h=OJQJ^Jh{hsYOJQJ^Jh{hi*OJQJ^J!jhi*OJQJU^J!jNhi*OJQJU^Jhi*OJQJ^Jjhi*OJQJU^J&jhi*OJQJU^JmHnHu"xz%`%@&B&0'2'"($())*)]gd {]gdsYgdsY 0^`0gdsYl parties in attendance should review and sign this agreement. Any additional comments may be written and attached to this form. Comments Attached? 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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] $2 z&'(*) H x*)  ".4<HNbnt  #),8>DPV^jps2>DP\bo$06BNTbryF4F4FF4F4F4F4F4F4F4F4F4F4F4FF4F4F4F4F4F4G G F4F4G G F4F4G G F4FG G 8@0(  B S  ?#Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Text12Text13Text14Text15Text16Text17Text18Text19Text20Text21Check1Check2Text25Text22Check3Check4Text26Text23Check7Check5Text27Text24Check8Check6#=c -E_t3Qp%Ccz  !"5Ou*?WqEc7Us=U2EFK$78=BU2EFK$78=B1 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={(i*DW;AyC@====L @     $UnknownG*Ax Times New Roman5Symbol3. *Cx Arial7@Cambria5. .[`)TahomaA$BCambria Math"h G G&GNGN!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$Susan Elizabeth Elswick (selswick)2Microsoft Office Word@F#@ L@Kӻ@KӻGN՜.+,0 hp  Rhode Island College PROBLEM IN FIELD FORM Title  !#$%&'()*+,-./012346789:;<>?@ABCDGHLKMWNOPQRSTUVXRoot Entry Fk׻JData 1Table"$WordDocument 72SummaryInformation(5DocumentSummaryInformation8=MsoDataStore׻:׻33VSCE2MAEMFZ1A==2׻:׻Item  PropertiesUMacros:׻p ׻VBA :׻!׻  !"#$%&'()*+,-./0123456789:;<=>? ]  b2N?e jt.GBV `?~1H[ڱxME ThisDocument *_VBA_PROJECTQ dirMPROJECTwmY)PS"SS"<<<<<(1Normal.ThisDocument00(%(*) 40@ ,Yi % %``H" `ophðAttribute VB_Name = "ThisDocument" Bas1Normal.VGlobal!SpaclFalse CreatablPre declaIdTru BExposeTemplateDeriv$CustomlizC1P Sub TextBox1_Change()  End a  *\G{000204EF-0000-0000-C000-000000000046}#4.1#9#C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA7\VBE7.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.5#0#C:\Program Files\Microsoft Office\Office14\MSWORD.OLB#Microsoft Word 14.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\Windows\system32\stdole2.tlb#OLE Automation*\CNormal*\CNormalO9Q(*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.5#0#C:\Program Files\Common Files\Microsoft Shared\OFFICE14\MSO.DLL#Microsoft Office 14.0 Object Library*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\Windows\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{E043B04B-36BF-4CC1-A902-3DDC18A040C9}#2.0#0#C:\Users\selswick\AppData\Local\Temp\Word8.0\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M  P9Q ThisDocument0?51fe3957ThisDocument c -Ҵ/DE-&` 'WordkVBAWin16~Win32Win64xMacVBA6#VBA7#Project1 stdole`Project- ThisDocument< _EvaluateNormalOfficeuMSFormsCTextBox1SDocumentjTextBox1_Change=`"$& 0* pHdProjectQ(@= l P9Q J< rstdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\Windows\system32\e2.tlb#OLE Automation`ENormalENCrmaQF  *,\C OmA!OfficgODficg!G{2DF8D04C-5BFA-101B-BDE5gAAe42ggram Files\@CommonMicrosoft Shared\OFFICE14\MSO.DLL#M 14.0 Ob Library%xMSFAs>AMSFBs$3@dD452EE1-E0D8F0A-8-02608C4D0BB4dFM260L'B p&/;"1D|~ AC00}#0B#G 50 AEB04B-36BF-4CC1-A902-3DDC18A040C96User@elswick\AppData\Local\Temp\Wor0d8.0d8.e