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* 1. Field Liaison Name

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* 2. Name of Agency

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* 3. What learning experiences has the student had (caseload, groups, macro experiences)?

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* 4. What are the strengths of the agency?

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* 5. Field Instructors Name

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* 6. What are the stengths of the field instructor?

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* 7. Do you have any concerns about the placement? Explain

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