Student Placement Request Form

Student Placement Request Form

Please complete this form if you are requesting a student placement with the YMCA of Greater Toronto Child and Family Development. Please Note: Not all requests can be accommodated and due to the large volume of applications you will only be contacted if we are considering your placement.

Please be aware if a placement is granted all students must be able to provide the following documentation:

1) Have the support of your Educational Institution

2) Be able to provide a police Record Check with Vulnerable Sector Search

3) Show proof of Regional Immunizations including a TST (TB) test

What is your role?*

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How many students are you looking to arrange placements for?*

Name*

Please enter your first and last name

Phone Number*

Please enter your primary phone number

Email Address*

Please enter your email address. Please Note: email is often the primary method of communication for individual placement requests.

School Name*

Please enter the school in which you are attending and that is requiring this placement

Program*

Please enter the school program that requires the placement. Example: ECE Program

Anticipated Graduation Date*

When you will be graduating (Best Estimate)

Total Number of Placement Weeks*

Please enter below the total number of weeks of your placement request

Placement Start Date*

Please enter the placement start date - If it can be flexible please indicate that in the notes section.

Placement End Date*

Number of hours needed per week*

Please enter the number of hours per week required for this placement

Are there specific days of the week the placement needs to take place on?*

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What are the specific days?*

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What classroom(s) are you looking for a placement in?*

Please select all that apply.

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In what city or cities are you looking for placement(s) in?*

Please keep in mind the more cities you are willing to travel to the more likely we will be able to proceed with your request. Indicating only ONE city will LIMIT your opportunities for a placement spot.

We operate programs in the following cities:

Durham - Pickering, Ajax, Whitby, Brooklin, Oshawa, Courtice, Bowmanville, Newcastle, Port Perry, Uxbridge, Beaverton

Toronto - Scarborough, East York, North York, Metro Toronto (Downtown Core), Etobicoke

York - Markham, Unionville, Richmond Hill, Vaughan, Aurora, Newmarket, Woodbrige, King

Peel - Mississauga, Brampton, Bolton, Caledon

Hallton - Miton, Georgetown

Dufferin - Orangeville, Shelburne

Address

Please enter your street address and postal code

Are you a current YMCA staff?*

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Who is your YMCA supervisor?*

Which YMCA centre do you currently work in?*

Will your placement affect your YMCA work schedule?*

YES

Schedule Explanation*

If your placement woudl affect your work schedule please explain below

Do you understand and that you will not be compensated (paid) for your field placement hours?*

If completing field placement hours outside of your work schedule do you understand that you will not be compensated?

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Discussed with School*

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Notes

Please add any additional comments or notes about your placement Request.

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