CFM 251: Ministry Practicum Application Form
Review the CFM 251 syllabus
here
before completing this application
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Student ID Number
*
ex. 12345
Email
*
example@example.com
Class
*
Freshman
Sophomore
Junior
Senior
Other
Have you met with Sherri Shackel yet?
*
Yes
No
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 Major
CFM Minor
Discipleship Certificate Student
Leadership Certificate Student
Other
Academic Advisor
*
First Name
Last Name
Practicum Begin Date
*
-
Month
-
Day
Year
Date
Practicum End Date
*
-
Month
-
Day
Year
Date
Which semester is your Practicum taking place? (check all that apply)
*
Summer
Fall
Spring
Practicum Title
*
Practicum Site Name
*
Practicum Site Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Practicum Site Supervisor
*
First Name
Last Name
Practicum Site Supervisor Contact Number
*
Please enter a valid phone number.
Practicum Site Supervisor Email
*
example@example.com
Student Signature
*
Date
*
-
Month
-
Day
Year
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
*
Self-select 3-6 of the 9 objectives from page 2 of the syllabus (see chart with academically grounded, spiritually maturing, and practically skilled categories). Construct specific and tangible ways you will address the objectives you've selected ("I know [state objective] will be met when evidenced by...[insert your stated commitment]").
Submit
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