CFM 251: Ministry Practicum Application Form

CFM 251: Ministry Practicum Application Form
Review the CFM 251 syllabus here before completing this application
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student ID Number*
ex. 12345
Email*
example@example.com
Class*

FreshmanSophomoreJuniorSeniorOther
Check one or more of the following that apply. If your major is not CFM, please check the "other" box and enter your major.*

CFM MajorCFM MinorDiscipleship Certificate StudentLeadership Certificate StudentOther
Academic Advisor*

First NameLast Name
Practicum Begin Date*

MonthDayYear
Date
Practicum End Date*

MonthDayYear
Date
Which semester is your Practicum taking place? (check all that apply)*

SummerFallSpring
Practicum Title*
Practicum Site Name*
Practicum Site Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practicum Site Supervisor*

First NameLast Name
Practicum Site Supervisor Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Practicum Site Supervisor Email*
example@example.com
Student Signature*
Date*

MonthDayYear
Date
Practicum Vision Statement*
Identify why you are entering into this ministry practicum and what you hope to accomplish or learn by the end of your experience.
CFM Objective Completion*
Using the department objectives listed on the front page (with particular attention to column C "practically skilled"), identify specific and tangible ways you will address those three objectives. Also, highlight any other appropriate objectives you will meet with regard to "academically grounded" and "spiritually maturing." NOTE: requirements with CVC - 1) myStory interaction with CVC coach & 2) attend at least one Canvas program.
Should be Empty: