PracticumSiteInformationFormfinal.docx

Practicum Site Information Form

STUDENT INFORMATION

Shola Owoyemi

7736217034

Chicago

State: Illinios

Walden email address: [email protected]

Alternative email address: [email protected]

Time zone: EST

Student practicum site schedule:

Wednesdays and Friday :

03/02 :9am – 5pm, 03/04:9am – 5pm, 03/09: 9am-5pm, 03/11: 9am-5pm, 03/16: 9am-5pm, 03/18: 9am-5pm, 03/23: 9am-5pm, 03/25: 9am-5pm, 03/30: 9am-5pm, 04/01: 9am-5pm,04/06: 9am-

5pm,04/08 :9am-9pm, 04/13: 9am-5pm, 04/15: 9am-5pm,04/20 : 9am - 5pm, 04/22: 9am-5pm, 04/27:9am-5pm, 04/29: 9am-5pm, 05/04: 9am-5pm, and 05/06: 9am-5pm.

PRECEPTOR AND SITE INFORMATION

Preceptor name : Kishwar Ali

Preceptor credentials : MD

Site name: General Psychiatry Service

Site address: 3845 Mccoy Dr Ste 109

City/town: Aurora

State: Illinios

Preceptor email address: [email protected]

Preceptor phone number: 6302670451

Site phone number: 6308981031

Field Site Clinic hours: 9am-5pm