Practicum Student Application
Name
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First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
High School
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College
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Graduate Level
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How would you describe your relationship with God?
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Describe the reason(s) as to why you would like to work in a Christian setting.
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What do you hope to gain from working in a Christian counseling environment?
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How do you see counseling in relation to the Christian ministry?
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Do you have any other experiences in teaching or counseling in a Christian-related environment? If yes, please explain.
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Which Julianna Poor Memorial Counseling Center site(s) are you interested in working at?
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The Loop - Mon-Fri — 7401 Katy Fwy, Houston, TX 77024
Cypress – Mon & Wed — 11011 Mason Rd, Cypress, TX 77433
Sienna – Tue & Thurs — 4309 Sienna Pkwy, Missouri City, TX 77459
What population of clients do you want experience with?
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Adults only
Marriage
Children
Teens
Family
Ministry Related Reference
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Other References
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Upload your resume.
*
Upload your transcript.
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