Practicum Placement Questionnaire - Updated January 2024
Should you wish to be considered for a practicum placement, we ask that you complete this questionnaire to the best of your abilities and then send your resume to rachel.brushett@icloud.com.  
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Email *
Today's Date *
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YYYY
Your Name *
Best phone number to get ahold of you at? *
Best email to get ahold of you at? *
1) What college are you with? *
2) What program are you in presently? *
3) What timeframe of practicum are you looking for? *
4) What kind of practicum are you looking for?  *
If you are a diploma student, please continue with question # 9
As diploma students do not carry a caseload the following few questions do not apply.
5) If Master's level are you comfortable holding a caseload?
Clear selection
6) If Master's level how do you feel about working with children?
Clear selection
7) We understand that some programs have restrictions on seeing children, however, we have had other students that have gotten special approval to see children aged 7+.  If you were able to get approval, is it something you would be interested in?
Clear selection
8) If so, would you consider taking a “purple stream” course at the Rocky Mountain Play Therapy Centre in Calgary https://rmpti.com/foundations-in-therapeutic-play-skills/ However, we are unaware of their calendar during the time of your practicum.
Clear selection
9) What days and times are you available, or what days and times are required for your practicum? *
10) How many hours per week are you needing? *
11) What are you hoping to learn from your practicum? *
12) What would you want from a supervisor? *
13) What areas are you wanting to learn more about? *
Thank you for taking the time to complete the questionnaire.
As we do have several practicum students contacting us for placements, we appreciate you taking the time to let us get to know you a little better to make sure we are the best fit for your needs and ours.  Once we have received your answers, we will contact you for an interview.  Upon completion of the interview, we will check your references and advise you if you are the successful candidate for that timeframe.
A copy of your responses will be emailed to the address you provided.
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