Shands Arts in Medicine » UF Health » University of Florida

Practicum Pre-Placement Form

This form is designed to help us understand more about your relevant experience as it might relate to arts in health and to learn about your goals in an effort to find the best placements for you for your Practicum course.

Your Name(Required)

Your Email Address(Required)

Your Phone Number(Required)

1. What experience/training do you have in the art modality in which you are getting your certificate? (please list at what age you started and for how many years)(Required)

2. Do you have a favorite style, genre, or medium in your chosen modality? Indicate below.(Required)

Examples: jazz- for musicians, modern- for dancers, sculpture- for visual artists

3. Do you have skills, background and interest in a modality other than what you are currently in your certificate for? Please describe the modality and your background/skill level.(Required)

For example, you may be enrolled in the dance in medicine certificate but also be a classically trained pianist.

3. Do you see yourself preferring to volunteer in the hospital, in your surrounding community or both?(Required)

4. Have you ever volunteered in a hospital, clinic or healthcare facility before? If so, please describe the setting.(Required)

5. What is your comfort level with working with seriously ill or disabled individuals?(Required)

6. Is there a particular population that you’re drawn to work with? A specific age group, health condition etc?(Required)

PLEASE NOTE: there is no guarantee that there will be placement for your preference

7. Practicum placements require a semester-long commitment and attendance of the entirety of your shift each week. Placement shifts can range from 3 to 6 hours a week. Are you able to meet the requirements of this placement in the upcoming semester?(Required)

Yes

Not Sure Yet

8. In order to volunteer with AIM on hospital property, you will be required to provide proof of the listed vaccinations as well as the trainings. Failure to submit proof of vaccinations and trainings prior to the start of the semester may impact your start date and your ability to successfully complete the practicum course. CURRENT SERVICE LEARNING CHECKLIST REQUIREMENTS : MMR vaccine, Varicella Vaccine, Tuberculosis screening form, Hepatitis B Vaccine, Tdap (tetanus/diphtheria/pertussis) Vaccine, Flu Vaccine, HIV/AIDS training, HIPAA training, Level 1 background check (certain locations require Level 2).(Required)

I understand that my placement start date is dependent on completion of all required items listed above

*Requirements may vary depending on placement. If you have a concern over any of these requirements, contact your academic advisor or course instructor.