Student Practicum Application

Student Practicum Application
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Educational Background
Current Academic Institution:*
Program of Study:*
Semester Level:*
Expected Graduation Date:*
Availability:
Please indicate your availability for practicum. Check all that apply.*

Fall SemesterSummer SemesterWinter Semester
Preferred Days and Times:

Please specify the days and times you are available for the selected practicum and/or internship:
Times slots available:

Morning: 10:00am - 1:00pm

Afternoon: 1:00pm - 4:00pm

Evening: 4:00pm - 8:00pm

Weekends: 9:00am - 2:00pm

Please choose ALL available hours that apply.
Sunday*

MorningAfternoonEvening
Monday*

MorningAfternoonEvening
Tuesday*

MorningAfternoonEvening
Wednesday*

MorningAfternoonEvening
Thursday*

MorningAfternoonEvening
Friday*

MorningAfternoonEvening
Saturday*

MorningAfternoonEvening
Interest and Qualifications:
Why are you interested in completing your practicum at Hamilton Counseling and Consulting?*
Describe your experience and interest in providing clinical services for children, adolescents, and adults.*
Working as part of a dynamic team is important at Hamilton Counseling and Consulting. Please share your experiences collaborating with others in a professional setting.*
Elaborate on your desire to develop and improve your clinical skills during your practicum and/or internship.*
References:

Please provide the names and contact information of two academic or professional references who can speak to your qualifications and potential as a practicum student.
Reference #1
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Reference #2
Name*

First NameLast Name
Relationship*
Email*
Phone Number*
Resume and Cover Letter:

Upload a copy of your resume, a copy of a de-identified written Clinical Case Conceptualization, and a cover letter.
File Upload*

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By submitting this application, you confirm that the information provided is accurate and complete. You also understand that the selection process for practicum students at Hamilton Counseling and Consulting may involve interviews and reference checks.
Signature*

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Student Practicum Application

Personal Information

Educational Background

Availability:

Preferred Days and Times:

Interest and Qualifications:

References:

Reference #1

Reference #2

Resume and Cover Letter: