Guidance for On-Site/Virtual Clinical Placements & Internships During Covid-19

  • The purpose of this form is to ensure that you have considered the risks inherent in your fieldwork placement(s) and are willing to take all possible precautions to keep yourself healthy and safe.
  • Part I: Considerations

    If the answer to any of the below questions is “no,” it is recommended that the student not begin their placement. If the answers are “yes,” SOIS may still decide, in its discretion, not to place a student at a particular site based on the totality of the circumstances.
  • Part II: Student Acknowledgement

    By completing this form, I am agreeing to the following:  
    • • I wish to accept the above-described on-site or virtual placement at a non-UWM site in connection with my UWM course of study.
    • • I understand there are risks associated with on-site placement during the COVID-19 pandemic and I agree to accept such risks.
    • • I understand that I may decline the above-mentioned placement and the range of options available to me if I am not comfortable being placed at this time have been explained to me.
    • • I agree to follow any requirements for clearance at the site (e.g. testing, screenings, etc.), as well as any guidance provided by the site and/or UWM regarding safety precautions when returning home from the site.
    • • I have had the opportunity to ask any questions I have about the above-described placement and I will contact program coordinator Susan Hersh ( with any future questions and/or concerns about my placement.
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