1 Start 2 Section 1 Page Break 3 Section 2 Page Break 4 Section 3 Page Break 5 Section 4 Page Break 6 Complete Page 1 of 6 Students requesting a Spring 2021 PS II practicum placement should complete this online form by 4:30 p.m. on Monday, November 23, 2020. Students who have dependent children, marital or health considerations, or those who are involved in University sanctioned extra curricular activities will need to provide the necessary supporting documentation in order to have those situations taken into consideration for practicum placements. Students wishing the above and applicable situations from Section V of this form to be considered, MUST provide the required supporting documentation to Field Experiences. (Unsupported situations will not be taken into consideration.) Students should note however, that providing supporting documentation will not be a guarantee that a student will be placed locally, or within a commutable distance based on the above. Employment will not be a guarantee of a local (Lethbridge) practicum placement; students must be prepared to travel. Students who do not provide all relevant information, or who provide false information, may be required to withdraw from the practicum and re-apply for admission to resume their studies in a subsequent year. Should you have any questions, feel free to contact Jaime Iwaasa via email at jaime.iwaasa@uleth.ca; via phone 403-329-2448. SECTION I: CONTACT INFORMATION U of L ID Number * Last Name * First Name * U of L Email Address * Address Please provide the address of the residence that you will be living at while attending university via online classes for the Spring 2021 term. NOTE: This is the address that will be used in making your Zone 6 Professional Semester II practicum placement. City Province Postal Code Phone number (use 403-123-4567 format) Emergency Contact Name Emergency Contact Phone Number (use 403-123-4567 format) Emergency Contact Relationship To You Leave this field blank Next Page >