McGill University
Faculty of Medicine and Health Sciences
School of Communication Sciences and Disorders
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Placement Offer Form - Outside of the Montreal Area
Site Information
Site Name
*
Address
*
Type
*
School Board
Specialized School
Hospital
Rehabilitation Centre
Private Practice
CLSC or Community Clinic
Other, please specify below:
Other
Immunization Requirements
Security Check Requirements
Criminal Record Check
Vulnerable Sector Screening
Time Frame of Security Check
6 months
12 months
2 years
Other, please specify below:
Other
Clinical Educator(s) (CE) Information
Name
*
Phone Number
*
E-mail
*
Days Worked
*
2nd CEs’ Information (if applicable)
Name
Phone Number
E-mail
Days Worked
Contact Person (if different than CE)
Name
Title
Phone Number
E-mail
Language Requirements
Please check all that are applicable
Bilingual Placement
Perfectly Bilingual (can speak, understand, read and write without mistakes)
Fluently Bilingual (can understand and read perfectly; make some mistakes with speaking and writing)
Conversational French (Can somewhat participate in meetings or discussions)
Functional French (understands what is going on in discussions and can read files)
English Only Placement
English Only
French Only Placement
Francophone Student Required
French Speaking Anglophone looking to perfect their French (It is ok if the student’s French is not perfect)
Other information
Placement Offer(s) for our Master’s Students
1st Year Students
Spring Practicum
20 full days (around 7-8 hours) Paediatric or adult populations Some observations, shared practice towards some independence Usually starts on the last week of April and later
Spring practicum time
4 days a week
5 days a week
Other, please specify below:
Other
2nd Year Students
Final Internship
60 full days (around 7-8 hours) All populations (adults, paeds, specialized…) Initial shared practice with a goal of independent practice With specialized populations, students may not develop complete independence Usually starts on the last week of April and later.
Final internship time
4 days a week
5 days a week
Other, please specify below:
Other
Clientele Served
Age of Clientele
*
0-3 years old
4-5 years old
6-12 years old
13-18 years old
18-65 years old
65+
Other information:
Other
Type of Clientele: General
*
Developmental Language
Articulation/Phonology
Motor Speech
Acquired Language
Fluency
Voice/Resonance
Dysphagia
Type of Clientele: Specific
*
Allophone
Alternative and Augmentative Communication
Aphasia
Autism Spectrum Disorders
Cerebral Palsy
Childhood Apraxia of Speech
Cleft Palate and Cranio-Facial Anomalies
Cognitive Communication Disorders
Degenerative Disease
Hearing Loss
Intellectual Disabilities
Language Delays
Language Disorders
Laryngectomy
Learning Disabilities
Low Socio-economic Status
Neuromuscular Disease
Oncology
Specific Language Impairment
Stroke
Tongue Thrust
Traumatic Brain Injury
Written Language Impairments
Other, please specify below
To select more than one item, press and hold the CTRL key while selecting.
Other
Peer Coaching Model
Peer coaching
*
I have done Peer Coaching in the past and would like to continue
I have not done Peer Coaching, but would be open to it this semester with simultaneous training and support
I am not interested in Peer Coaching at this time
Additional Information/Comments
Leave this field blank
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