Counseling Center Practicum Application
Thank you for your interest in a practicum at The Grove Counseling Center. Please submit and attach all required documentation below. We will review the information and contact qualified parties about interview dates.
Name *
First and last name
D.O.B. *
MM
/
DD
/
YYYY
Are you Bi-lingual?
If yes what language(s)
Preferred Email address: *
Phone number *
Which position are you applying for? *
Do you have a personal relationship with Jesus Christ? *
What Church do you currently attend? *
Briefly summarize your testimony: *
Why did you decide to become a counselor? *
What are your strengths? *
What is your preferred target population ? Why? *
Why are you interested in the Grove Counseling Center? *
When will you be able to start practicum? *
Hours/Days of availability to see clients: *
Morning
Afternoon
Evening
Unavailable
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Are you available to participate in Monday Night Support Groups (7pm-8:30pm) *
Have you completed the following courses *
Yes
No
Will be completed by time of practicum
Counseling Theory /Techniques (may be combined or two classes)
Professional Law and Ethics
Professional Practice Seminar (1 and 2 if courses are split)
Submit your Transcripts (unofficial or official) Confirming completion of the courses above: *
Required
Submit your Resume *
Required
Submit
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