JFKU Community Counseling Center Concord

Community & School - Based Trainee Application

MFT & PCC Program/Holistic Program/PsyD Program-Internal & External Applicants Rev. 2/12/19
Application Instructions:

This application will not allow you to save and return to it at a later time. It is suggested that you complete answers to the questions on a word doc and review all neccessary documents and information you will need to submit first. When you have all neccessary documents and information, you may upload them and copy and paste your responses to each question from your word doc at the time you are ready to submit.

If you have any questions, you may reach out to Jes Moniz, Manager of the Community-Based Counseling Program (jmoniz@jfku.edu).

After you submit, a member of our team will reach out to you to schedule an interview within two to three weeks.
Date

Month Day Year
Date
Are you currently a JFKU Student? *

Yes No
What quarter are you applying for practicum? *

Fall Quarter (October - December) Winter Quarter (January - March) Spring Quarter (April - June) Summer Quarter (July - September)
If you are not a JFKU student, please identify the College or University you are currently attending.
External Trainees Only: When does practicum begin at your College or University?

Month Day Year
Name *

First Name Last Name
Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Cell Phone *

Area Code Phone Number
Home Phone

Area Code Phone Number
Email Address, if JFKU student, list your JFKU email address *
Student ID # *
Who is your JFKU Faculty Advisor? *
Please write N/A if you are not a JFKU student
Who is your JFKU Program Chair?: *
Please write N/A if you are not a JFKU student
If you are not a JFKU student, who is your Practicum/Placement Coordinator?
Please provide the contact number for this person.
Before beginning your practicum, will you have completed all required classes on your program flowchart? Your Academic Counselor of your program will verify your ability to start your practicum. Please note you must upload a copy of your program flowchart with your completed application. *

Yes No
Upload Program Flowchart
All applicants must upload a copy of their program flowchart or degree program
Counseling Psychology Program (select all that apply) *

Marriage and Family Therapy Professional Clinical Counselor Marriage and Family Therapy - Holistic (includes Depth/Somatic/Expressive Arts/ Transpersonal PsyD Ethnographic PsyD Clinical Practicum beginning PsyD Clinical Practicum Advanced PsyD Externship (Supplemental Practicum) If you don't see your program please list in the other box below
Education Status *
Graduation Date or Anticipated Graduation Date *

Month Day Year
Would this be a supplemental/secondary practicum for you? *

Yes No
Are you considering doing supplemental practicum in addition to your primary practicum? *

Yes No
Are you currently in a supplemental practicum(s)? *

Yes No
If yes, with what agency/agencies?
Please describe what you have learned from past clinical/work experiences. Please include your successes and challenges. *
What clinical areas are you interested in pursuing? Are there any areas you would like to specialize? *
What are your professional goals? *
Please list any languages other than English that you speak/sign: *
Essay Questions
1. What worked well for you with previous managers/supervisors? Please be specific. *
2. What did not work well for you with previous managers/supervisors? *
3. What did former mangers/supervisors identify as your challenges? *
4. Explain the process of how you have addressed these challenges. *
5. What did former managers/supervisors identify as your strengths? Please provide examples. *
6. What types of clients and/or issues do you feel you will work best with and why? *
7. Please describe your experiences working with marginalized and diverse communities, in community mental health, social justice, or embracing the principles of wellness, recovery, and resiliency. If you have not had these types of experiences, then discuss why you are seeking the kind of experiences this position will offer. *
8. What life changes do you need to make to be able to successfully meet the expectations of this position? *
9. How do you practice self-care in your daily life? *
10. As a part of certain academic programs, students are required to participate in their own personal psychotherapy or spiritual practice. Are you currently participating in psychotherapy/spiritual practice? If yes, please describe how this experience has benefited you. *
References

As part of the application we require a list of references. Please indicate your professional or academic references below. We require that all applicants include at least an email or phone number for each reference.
Reference 1 *

First Name Last Name
Reference 1: Relationship *
Reference 1: Phone Number *

Area Code Phone Number
Reference 1: E-mail *
Reference 2 *

First Name Last Name
Reference 2: Relationship *
Reference 2: Phone Number *

Area Code Phone Number
Reference 2: Email *
Reference 3 *

First Name Last Name
Reference 3: Relationship *
Reference 3: Phone Number *

Area Code Phone Number
Reference 3: Email *
Attachments

Please upload your Resume/CV and cover letter.
Upload Cover Letter *
Upload Resume *
If accepted to our program, you will receive an email with an additional practicum packet. This will contain infomation regardining the additional documents we will require prior to the start of your practicum:
- Proof of Department of Justice (DOJ) Clearance (Live Scan Fingerprinting)
- Proof of Tuberculosis (TB) Testing Clearance (last year)
- Proof of Malpractice Insurance ($1M-$3M) this applies to all applicants
- Practicum Readiness Form
- Availablilty Form
It is the Program's policy that all trainees must be in their own personal psychotherapy no later than the first day of their practicum.

Thank you for applying to the John F. Kennedy University Community Based Counseling Program. By submitting your application you affirm that all information reported in this application is true and complete, and that you have carefully read our requirements.
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Community & School - Based Trainee Application

Essay Questions

References

Attachments