PULSE Learning-Work Agreement Addendum
Student ______________________________ Supervisor ________________________________
Placement _____________________________ PULSE Professor __________________________
1) Please describe any alterations or adjustments to the student’s learning goals.
2) Please describe any alterations or adjustments to the student’s tasks.
3) Please describe any alterations or adjustments in the qualities you expect the student to develop and/or
exhibit in working at your agency.
4) Please describe any alterations or adjustments to supervision and guidance.
5) Please describe any alterations or adjustments to the student’s schedule.
6) Please describe any alterations or changes in your policies on punctuality, absences and missed shifts,
and make-up time:
Student: I agree to the adjustments outlined above. I realize that my placement work will be evaluated based on my
adherence to the terms outlined here. I acknowledge that these expectations will form the basis for my placement
grade at the end of the semester.
Signature _____________________________________________
Supervisor: I agree to the adjustments outlined above regarding learning goals, placement tasks, work schedule, and
supervision. I will evaluate the student’s placement work based on his/her adherence to this agreement.
Signature _____________________________________________
How to Submit This Document to the PULSE Office:
1) Both the student and the supervisor should keep a copy of this signed document.
2) The student is responsible to bring this Addendum to the PULSE office (Stokes 125N) as soon as completed.