Practicum Student Application

Practicum Student Application
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
High School*
College*
Graduate Level*
How would you describe your relationship with God?*
Describe the reason(s) as to why you would like to work in a Christian setting.*
What do you hope to gain from working in a Christian counseling environment?*
How do you see counseling in relation to the Christian ministry?*
Do you have any other experiences in teaching or counseling in a Christian-related environment? If yes, please explain.*
Which Julianna Poor Memorial Counseling Center site(s) are you interested in working at?*

The Loop - Mon-Fri — 7401 Katy Fwy, Houston, TX 77024Cypress – Mon & Wed — 11011 Mason Rd, Cypress, TX 77433Sienna – Tue & Thurs — 4309 Sienna Pkwy, Missouri City, TX 77459
What population of clients do you want experience with?*

Adults onlyMarriageChildrenTeensFamily
Do you currently have a job or plan to have a job during your practicum that affect the hours you are available to see clients?*
Ministry Related Reference*
Other References*
Baptist Faith and Message 2000 Agreement

I have read the Baptist Faith and Message 2000 and agree to counsel in a manner that is consistent with it.*
Baptist Faith and Message 2000

*Please contact Steve Crain (Steve.Crain@HoustonsFirst.org) or Greg Curnutte (Greg.Curnutte@HoustonsFirst.org) if you have any questions or concerns about this requirement.
Upload your resume.*

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