ࡱ> { bjbj ff&*6-6-:::::T;;;;<;]^<=z???`ACE4FH\J\J\J\J\J\J\${_1b`n\i:zGPC@CzGzGn\::?`A\(I(I(IzG:?:`AH\(IzGH\(I(I X06Z?HR:Y$4\\0]^YbTHbH6Z6ZJb:ZzGzG(IzGzGzGzGzGn\n\H@zGzGzG]zGzGzGzGbzGzGzGzGzGzGzGzGzG6-X 9: Field Placement Proposal Submission Instructions for Students, Site Preceptors, and Faculty Advisors Proposal development is an iterative process, so students should be prepared to revise their proposals several times, and preceptors and advisors should be prepared to review multiple drafts of this document. Students should complete the form and then email it as an attachment to their faculty advisor, site preceptor, and the program coordinator all at once. Advisors, preceptors, and the coordinator will provide feedback and recommendations to all (so that they do not provide conflicting or repetitive advice), and the student will revise and resubmit the proposal in the same manner. Timely submissions and revisions are important because all students must receive approval from their site preceptors and faculty advisors before the batch of proposals may be submitted to the IRB Consultants, and students may not begin working on their projects until they have gained approval from the IRB Consultants. Therefore, if one proposal is late, all students must wait to begin their projects. When preceptors and advisors are satisfied with the proposal as it is written, they should review their responsibilities in Part V of the proposal and indicate their agreement and approval through an email to the MPH program at  HYPERLINK "mailto:mph@mcw.edu" mph@mcw.edu. Please contact the MPH program with questions or concerns: Phone: 414-955-4510 Email:  HYPERLINK "mailto:mph@mcw.edu" mph@mcw.edu Proposal Development Instructions for Students Part I. Contact Information Provide all of the requested contact information for yourself as well as your faculty advisor, preceptor, and site. Remember to include each persons credentials (MD, PhD, MPH, etc.) Part II. Field Placement Timeframe & Logistics Identify the arrangements you have made with the site regarding the timeframe of your Field Placement. Part III. Project Description Describe the nature and scope of your proposed public health project. Overview Provide a general overview of your project. Explain the purpose and importance of the project as well as how it will benefit the site. Also describe if there is any funding you will receive via a research grant to complete this project. Timeline of Activities & Outcomes Describe the activities you will complete and indicate the anticipated dates for conducting and completing those activities as well as submitting site and course deliverables (at least two products must be developed for the site). Include dates of meetings with your preceptor as well as midpoint and final evaluation conferences with your preceptor and faculty advisor. Participants/Private Health Information Identify if you will be working with any private health information or will be interacting with possible participants (i.e. surveys, questionnaires, or focus groups). Please provide a list of sample survey or interview questions if applicable. Resources Needed Explain arrangements for student workspace, access to information, personnel, data, equipment, and other materials necessary for completion of the project. Disseminating Information Describe your plans for sharing your project with the site and other stakeholders. Indicate if you are planning on publishing or submitting this project as a poster abstract or journal article. Part IV. Chart of Competencies Complete the chart that outlines how your activities will help you gain competency in the areas you have chosen to target during your Field Placement. Competencies Referring to your Competency Self Assessment, list the competencies you will enhance during your Field Placement. Competencies are outcomes that are linked to workforce needs, as defined by employers and the profession. For the most part, the competencies you list should correspond to those you identified as ones you would like to target during your Field Placement. Remember you should address at least six competencies from the list of MPH program competencies (at least three foundational competencies and one concentration-specific). Write the competency exactly as it appears in the Competency Self Assessment. Ex. Assess population needs, assets and capacities that affect communities health Apply basic theories and models from behavioral science disciplines that are used in public health practice Activities Distinguish the specific activities, which you will complete during your Field Placement that will help you achieve your competencies. Ex. Perform data analysis Interpret results of data analysis Write report describing results of data analysis Meet with public health officials to determine regional needs and resources Evidence Describe at least two products you will generate for the site. If asked for evidence to demonstrate that you have achieved your competency, what would you provide? Ex. Report describing results of data analysis Evaluation form for newly implemented program Part V. Responsibilities Review your responsibilities in carrying out the project. Part VI. Agreement & Approval Indicate your agreement to the responsibilities and approval of the Field Placement Proposal. Students provide their approval and agreement by submitting their proposal. Site preceptors and faculty advisors should email the MPH program at  HYPERLINK "mailto:mph@mcw.edu" mph@mcw.edu to indicate their approval and agreement. Field Placement Proposal Part I. Contact Information Student Name:  FORMTEXT       Email:  FORMTEXT       Faculty Advisor:  FORMTEXT       Phone:  FORMTEXT       Email:  FORMTEXT       Site Preceptor:  FORMTEXT       Title:  FORMTEXT       Phone:  FORMTEXT       Email:  FORMTEXT       Site Name:  FORMTEXT       Address:  FORMTEXT        FORMTEXT        FORMTEXT       Does this site have its own IRB?  FORMCHECKBOX  No  FORMCHECKBOX  Yes If yes, please identify:  FORMTEXT       Will the site require an IRB to review this project prior to initiation of any activities?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Part II. Field Placement Timeframe & Logistics Semester(s) and year(s):  FORMTEXT       Field Placement Start Date:  FORMTEXT       Anticipated Field Placement End Date:  FORMTEXT       Average hours per week at site:  FORMTEXT       How often will you meet with your Preceptor?  FORMCHECKBOX  Daily  FORMCHECKBOX  Weekly  FORMCHECKBOX  Biweekly  FORMCHECKBOX  Monthly Will the Site provide you with a stipend?  FORMCHECKBOX  No  FORMCHECKBOX  Yes If yes, please provide amount:  FORMTEXT       Date CITI training completed:  FORMTEXT       Will you receive any funding via a research grant to complete this project?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Will you be working directly with any identifiable private health information?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Will you be interacting with possible participants (i.e. administering surveys or  FORMCHECKBOX  No  FORMCHECKBOX  Yes questionnaires, conducting focus groups)? Are you planning on publishing or submitting this project as a poster abstract or journal article?  FORMCHECKBOX  No  FORMCHECKBOX  Yes Part III. Project Description Overview (purpose, importance, benefit to site, funding) Timeline of Activities and Outcomes (anticipated dates: completing activities, submitting deliverables) Participants/Private Health Information (surveys, questionnaires, focus groups) Resources Needed (student workspace, access to information, personnel, data, equipment) Disseminating Information (organization or community meeting, publication, poster presentation, abstract) Part IV. Chart of Competencies A. CompetenciesB. ActivitiesC. Evidence Part V. Responsibilities Student responsibilities in carrying out the project: Maintain CITI (Collaborative Institutional Training Initiative) certification throughout enrollment in the Field Placement course. Apply to the 91ɫƵ IRB if determined necessary by the IRB. Maintain a work schedule agreed upon with the preceptor. Complete the specified activities of the Action Learning Project. Regularly meet with the Site Preceptor to discuss progress. Complete a Midpoint Progress Report in collaboration with the preceptor and faculty advisor. Participate in an Exit Interview with the faculty advisor, preceptor and MPH program. 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K% '&(|)x,K|.&$2]5h@6;R,=?@yCgxIJ9KPiUX|X)^[(^Id3i'XlK@nxep+v8|j~2e(X 8%7)nXCH|?j*I|&`-oNp%w`z1 y`K|s1gTcf<rRd`K)f:N}I6DKE0>hT=_NNv"?[8Spp&&@dg"&@ "$&P@@Unknown G.[x Times New Roman5Symbol3. .[x Arial7..{$ Calibri7$BCambria5. .[`)Tahoma?= .Cx Courier NewC.,.{$ Calibri Light;WingdingsA$BCambria Math"1h8S8SF!F!F!x20&&I3qHP $PK)*! xx Jessica Gillis Angone, KellyH          Oh+'0h)  0 < H T`hpxJessica GillisNormalAngone, Kelly2Microsoft Office Word@F#@#$@I@I!G'VT$m    1."System- "SystemX+O%-"System--@"Calibri---  2 0 1  2 0    0''@"Calibri---@"Calibri--------- /2 B50 Field Placement Proposal          ---  2 B0   @"Calibri---  2 U00     2 g00    2 x0 0 Submission   2 xy 0 Instructions  2 x0   X2 x30 for Students, Site Preceptors, and Faculty Advisors   2 x0  @ Calibri---- @ !z0- @"Calibri---  2 00    +2 00 Proposal development   2 R0 is an iterative process, so students should be prepared to revise their proposals  2  0 several times  2 0 ,   >2 0"0 and preceptors and advisors should  2 0   2  0 be prepared  =2 U!0 to review multiple drafts of this    2 0   2  0 document.   2 V0     2 00    2 0N0 Students should complete the form and then email it as an attachment to their       2 0 f 2 0 aculty   2 50 a 2 <0 dvisor,   2 h0 s 2 n0 ite   2 0 p  2 0 receptor, and  2 0 the    2 00 p 2 80 rogram    2 g0 c 2 m 0 oordinator  2 0   2 0 all at once.  2 0    2 0   22 0 Advisors, preceptors, and  "2 0 the coordinator  2 0   2 0 wil  /2 0 l provide feedback and r "2 0 ecommendations    &2 00 to all (so that th  2 0 e  2 0 y  2 0   2 h0 do not provide conflicting or repetitive advice), and the student will revise and resubmit the proposal     (2 00 in the same manner.    2 0     2 00    v2 ,0G0 Timely submissions and revisions are important because all students mus     82 ,0 t receive approval from their    2 ,0 s 2 ,0 ite   2 ,0 p 2 , 0 receptors   2 =00 and   2 =J0 f 2 =O0 aculty   2 =u0 a 2 =|j0 dvisors before the batch of proposals may be submitted to the IRB Consultants, and students may not begin      2 O0[0 working on their projects until they have gained approval from the IRB Consultants. Theref   >2 OQ"0 ore, if one proposal is late, all   L2 a0+0 students must wait to begin their projects.    2 a00     2 s00    2 0Z0 When preceptors and advisors are satisfied with the proposal as it is written, they should     2 D0   =2 F!0 review their responsibilities in    .2 00 Part V of the proposal   72 0 and indicate their agreement    2 h0 a 2 o 0 nd approval  /2 0 through an email to the   2 I0 MPH    2 i0 p 2 q0 rogram   2 0   2 0 at   2 0 0 mph@mcw.edu     2 0 .  2 0  @ Calibri---- @ !b0-  ---  2 00   --- 2 00 Please  2 Z 0 contact the  2 0 MPH    2 0 p 2 0 rogram   42 0 with questions or concerns:   2 0    2 C0 Phone:  2 q0   2 w0 414  2 0 - 2 0 955  2 0 - 2 0 4510  2 0    0'' 2 C0 Email:   2 g0    2 k0   2 n 0 mph@mcw.edu     2 0  - @ !bn-   0''---  2 00     2 00    @ Calibri- @"Calibri- - -   "SystemX+O%- -   00//..xw v ՜.+,D՜.+,t hp  ; MicrosoftF& Field Placement ProposalLSubmission Instructions for Students, Site Preceptors, and Faculty Advisors;Please contact the MPH program with questions or concerns:/Proposal Development Instructions for StudentsPart I. Contact InformationQProvide all of the requested contact information for yourself as well as your fa0Part II. Field Placement Timeframe & LogisticsQIdentify the arrangements you have made with the site regarding the timeframe ofPart III. Project Description!Part IV. Chart of Competencies Ex. Perform data analysisPart V. Responsibilities:Review your responsibilities in carrying out the project. Part VI. Agreement & Approval QIndicate your agreement to the responsibilities and approval of the Field PlacemField Placement ProposalPart I. Contact InformationPart III. Project DescriptionPParticipants/Private Health Information (surveys, questionnaires, focus groups)QResources Needed (student workspace, access to information, personnel, data, equPart V. 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