2026 Practicum Application

Qualifications

This information will assist the review committee in determining if this is a good fit.
Education and degrees*
Professional registration or licensure # and state.*
Place of Employment*
Brief job description (current job)*
Work experience with dates. You may upload a resume for additional information.*
File Upload: Resume

Cancelof
Briefly identify what continuing education you have completed specific to neurological and/or developmental principles. Please include title and instructor when possible.*
Briefly list interventions which you have been exposed to but do not have formal training in.*

Other Information
What do you hope to learn from this experience? State your goals.*
Please list special interests and/or skills which you might be able to contribute.*
Such as music, sign language, etc.
Please identify any anticipated areas of challenge.*
Please indicate the camper gender you have interest in working with.*

FemaleMaleI do not have a strong preference either way
Please indicate the camper ages you have interest in working with. Check all that apply. (Please note we are not able to guarantee placements and age ranges may change slightly based on camper applications)*

6-7 years of age8-9 years of age10-11 years of age12-13 years of ageI do not have a strong preference

2026 Practicum Therapist Application