Paperwork Needed to Start an Externship
Paperwork Checklist for CDS 672 A/B
Paperwork Needed to Start an Externship
Your clinical externship application is not complete until the following information is provided to the instructor. Remember that we cannot place you without a complete application.
❑ Completed application, including student signature on “Student Responsibilities” section
❑ Copy of current CPR card (American Heart Association BLS for Healthcare Providers)
❑ Copy of current annual TB clearance
❑ Résumé (Please make sure you have included all employment. It is especially important that you list current employers in the field)
Paperwork Needed at Midterm
Your externship supervisor will go over a midterm review with you around Week 5 of your externship. You and your supervisor will retain a copy of that document and send a copy to the CSUN clinical instructor. In the event that your supervisor has concerns regarding your performance that require the development of an action plan, a copy of this plan should be submitted with your midterm evaluation.
❑ Completed and signed midterm Evaluation of Student Extern
❑ Copy of Action Plan (if warranted)
Paperwork Needed at End of Externship
Your clinical experience is considered complete when your supervisor and University instructor release you. At that time, the following items must be submitted to the CSUN clinical instructor of record:
❑ Completed and signed Record of Client Contact Hours
❑ Completed and signed Record of Diversity, Disorders, and Procedures
❑ Completed Student Evaluation of Externship Experience
❑ Completed Demographic Information for Clinical Externship Site
Supervisors must also submit:
❑ KASA Forms
❑ Completed and signed final Evaluation of Student Externship Experience
After all paperwork is received and hours verified, and work has been satisfactorily completed, a grade of “credit” will be issued. Final grades are issued by the University, considering the recommendations of the site supervisors.
If work is not completed by the end of the grading period, a grade of “incomplete” will be issued until all course requirements are satisfied.
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