Practicum Organisation Form

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First Name(s)

Surname

Email

Student Number

Home Address

Country

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Address

Post/zip code

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Mobile phone:

Who is your Regional Academic Staff Member?

What is the name of your current workplace? (Applicable if working in an early learning settings)

Please indicate your preferred placement dates (first and second choice)

Diploma/Degree: Placement dates need to be 5 consecutive weeks within the trimester (4 consecutive weeks for EDU617).

Graduate Diploma: Placement dates need to be 8 consecutive weeks within the trimester.

Most practicums have a workshop (except for EDU618, EDU717, 75302, EDU727), and these are usually held within the first 2 weeks of the trimester. You cannot start practicum until you have attended a workshop.

Placement date - first choice

Placement date - second choice

Please indicate what region/geographical area you would prefer (first and second choice)

Region/geographical area - first choice

Region/geographical area - second choice

Please indicate what service type and age group you would prefer (first and second choice)

For example, indicate whether you prefer to work with infants, toddlers, young children, mixed age or kindergarten, special character, etc. Remember that there needs to be a range of settings covered over all your practicums.

First choice service type	First choice age group	Second choice service type	Second choice age group

Please indicate if you have a preferred centre(s) and briefly why

Preferred centre option 1

Preferred centre option 2

Please list the centres and age groups you have previously worked and/or completed practicum in

Centre	Practica Completed (Yes/No)	Age group

Please note your employer, position held, and dates of employment.