Can the supervisor sign electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided the signer intends to sign, consents to electronic records, the signature can be attributed, and the record can be retained and reproduced.

Is notarization required?

Not typically for academic verifications. If a licensing board or external agency requires notarization, the form should be notarized according to the relevant state notary rules.

What if the supervisor cannot be reached?

Document attempts to obtain the signature and follow your program’s escalation process; some boards accept supervisor attestations from program coordinators when accompanied by supporting documentation.

How long should we keep signed verifications?

Keep verifications per institutional retention policy and applicable law: at least 3 years for many administrative purposes, 6 years for HIPAA-related records, and longer if required by licensure authorities.

Can a student submit a scan of a signed paper form?

Yes, scanned signed documents are acceptable if they include an original signature or a notarized copy when required; ensure scans are legible and stored with an audit trail if accepted electronically.

What happens if hours are disputed?

Maintain contemporaneous placement logs, supervisor notes, and any communication records; these support resolution and reduce the risk of training or credentialing disputes.

Electronic Signature
Templates
Education
Student Fieldwork Verification

Student Fieldwork Verification

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

STUDENT FIELDWORK VERIFICATION

This form certifies the placement, participation, and verified hours of the student named below while engaged in supervised fieldwork for academic credit or program requirements. The Site Supervisor certifies the accuracy of hours and performance evaluations. The Academic Program verifies acceptance of the fieldwork toward program requirements.

Student Information

Full Legal Name

Date of Birth:

Student ID:

Program/Major:

Contact Information

Fieldwork Placement

Agency / Organization Name Placement Address

Site Supervisor:

Title:

Fieldwork Details & Hours

Start Date:

End Date:

Total Required Hours:

Hours Completed:

Typical Weekly Schedule (days/hours) Primary Duties and Responsibilities

Learning Objectives and Competencies

Program Learning Objectives Addressed

The Site Supervisor attests that the student engaged in supervised activities consistent with the learning objectives and program competencies listed above.

Compliance & Documentation

The following items are required for placement. Check each item that has been provided to or confirmed for the student.

Pre-Placement Requirements Background check completed and cleared Required vaccinations/immunizations documented Required orientation/training completed Professional liability/insurance confirmed where required

Supervisor Comments on Attendance and Performance

Certification & Release

By signing below, the Site Supervisor certifies under institutional policy that the hours and performance described herein are true and correct to the best of the supervisor's knowledge. The Site Supervisor acknowledges responsibility for direct supervision of the student in accordance with applicable professional standards and program agreements. The Academic Program’s signature confirms acceptance of the verified hours toward the student's program requirements.

The student consents to release of verification information to the Academic Program for the purpose of credit award, licensure documentation, or program records. This form does not alter liability arrangements between the placement site and the institution; such arrangements are governed by any separate memoranda of understanding or placement agreements.

Attachments Provided (time logs, evaluations)

Student Acknowledgment

Student Printed Name: Student Signature: Date:

If the student is a minor, the parent/guardian must sign on the line above and provide relationship to student and contact information in the supervisor comments section.

Site Supervisor: Printed Name

Site Supervisor:

By:

Date:

Academic Program / Faculty: Printed Name

Program Representative:

By:

Date:

What the Student Fieldwork Verification Is

A Student Fieldwork Verification is a written confirmation that documents a student's supervised field placement, practicum hours, or clinical experience for an educational program. It typically records placement provider details, dates and hours completed, supervisor name and title, tasks performed, and whether the student met required competencies. Institutions use the form to verify eligibility for course credit, licensure documentation, or program completion. The verification may be completed by a field supervisor, site administrator, or designated school official and retained by both the school and placement provider for compliance and audit purposes.

Why a Clear Verification Matters

A complete, accurate verification supports academic records, licensure applications, and placement audits while reducing disputes about hours or supervision.

Who Typically Prepares and Receives This Verification

The form is prepared by field supervisors or site administrators and submitted to the student’s academic program to confirm placement details.

Field supervisors who directly observe and evaluate student performance, often responsible for signing the form.
Academic program coordinators who collect verifications to document course credit and meet accreditation standards.
Students who need verified documentation for licensure, transcripts, or career records.

Copies are kept by the student, the academic institution, and the placement site for credentialing, audits, or future employer verification.

Authorized Signers and Contact Roles

Field Supervisor

Typically a licensed or qualified practitioner who directly supervised the student; provides dates, hours, scope of duties, and an evaluative signature attesting to competency and attendance.

Academic Coordinator

A school or program official who reviews the verification for completeness and files it in the student record; may certify approvals required for graduation or licensure submissions.

Essential Information to Include

Student Name: Full legal name

Student ID: Institution ID number

Placement Site: Organization name

Supervisor: Name and title

Dates & Hours: Start/end dates

Scope: Tasks and competencies

Common Preparation Pitfalls

Incomplete dates or missing total hours cause delays for credentialing and licensure submissions and can trigger requests for re-verification.
Using informal or unclear job descriptions rather than specific task lists makes it harder to assess competency against academic requirements.
Signatures without printed names, titles, or organizational affiliation may be rejected by licensing bodies or accreditation reviewers.
Failing to preserve an audit trail or copy of the signed verification creates risk when a student disputes hours or supervisor confirmation.

Consequences of Incorrect or Missing Verifications

Delayed Licensure: Applications may be postponed

Academic Hold: Graduation or credit may be withheld

Audit Findings: Accreditor may require remediation

Financial Impact: Resubmission costs or administrative fees

Reputational Risk: Site or program credibility harmed

Legal Exposure: Potential disputes or claims

How to Complete the Verification Form

Follow this sequence to ensure the verification is complete, consistent, and acceptable to academic and licensing reviewers.

01

Record identity: Enter student full legal name and institution ID
02

Document placement: List site name, address, and supervisor details
03

Log dates: Enter start/end dates and total hours
04

Sign and date: Supervisor signs and adds printed name and title

Configuring an Online Verification Workflow

Set up a digital workflow that enforces required fields, routes to the supervisor, and archives a signed copy for records.

Field	Configuration
Required Fields	Make name, ID, dates, hours mandatory
Routing	Send to supervisor then program coordinator
Authentication	Use email or SMS code for signer ID
Storage	Archive signed PDF in student record

How to Share and Sign the Verification

Choose a sharing method that balances signer convenience with identity assurance and auditability.

Email Link: Send a secure signing link
In-Person: Print and sign on site
Kiosk / Tablet: Allow on-site digital signing

Timing and Submission Expectations

Follow institutional deadlines and allow lead time for supervisor response and any required notarization or authentication.

End-of-Term Submission:

Submit verifications by the program’s published deadline

Licensure Applications:

Allow extra time for processing and any credential checks

Supervisor Response Time:

Request signature at least two weeks before deadline

Notarization Lead Time:

Add time if an official notarized copy is required

Record Retention Start:

Retention begins on verification date

Key Processing Milestones

Sequential milestones help track a verification from request to archival and any downstream licensing use.

01

Request Issued

Program sends verification request to supervisor

02

Supervisor Signs

Supervisor completes and signs the form

03

Program Review

Coordinator checks for completeness and approves

04

eSignature Pricing Snapshot for Verification Workflows

Compare common vendor starting prices and feature availability for institutions evaluating eSignature platforms for verification forms; signNow appears first as the primary reference.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Real-World Examples of Verification Use

Examples show how programs and supervisors typically complete and rely on verifications in practice.

University Nursing Program

A clinical coordinator requests signed verifications each rotation to confirm hours and competencies

The hospital supervisor completes the online form and signs electronically
The coordinator stores the signed PDF in the student file to support board licensure applications and accreditation reviews.

Social Work Practicum

A community agency documents weekly supervision and client-contact hours for a practicum

The field instructor logs dates and provides a competency rating
The student retains a copy for job applications and the school archives the verification for five years for audit purposes.

Frequently Asked Questions

Answers to common questions about completing, signing, and storing Student Fieldwork Verification forms.

Need help? Contact support

Can the supervisor sign electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided the signer intends to sign, consents to electronic records, the signature can be attributed, and the record can be retained and reproduced.
Is notarization required?
Not typically for academic verifications. If a licensing board or external agency requires notarization, the form should be notarized according to the relevant state notary rules.
What if the supervisor cannot be reached?
Document attempts to obtain the signature and follow your program’s escalation process; some boards accept supervisor attestations from program coordinators when accompanied by supporting documentation.
How long should we keep signed verifications?
Keep verifications per institutional retention policy and applicable law: at least 3 years for many administrative purposes, 6 years for HIPAA-related records, and longer if required by licensure authorities.
Can a student submit a scan of a signed paper form?
Yes, scanned signed documents are acceptable if they include an original signature or a notarized copy when required; ensure scans are legible and stored with an audit trail if accepted electronically.
What happens if hours are disputed?
Maintain contemporaneous placement logs, supervisor notes, and any communication records; these support resolution and reduce the risk of training or credentialing disputes.

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