PSYCHOLOGY PRACTICUM APPLICATION
Read “Securing Your Practicum” in print or on the department website.
Complete this application and bring it to your first interview with Dr. Beck or Dr. Dalton.
Name:
Phone Number(s):
Email address(es):
Home Mailing Address:
Intended Practicum Term (Semester/year):
Intended Graduation Date (Month/Year):
Credit hours completed (when Practicum would begin):
When did you complete the Experimental Applications course?
How many credits do you wish to earn in Practicum*? _____
*One credit for each 40 hours worked in a field setting, IN ADDITION TO attending class and completing reading and writing assignments. Fall & Spring: 3-15 credits. Summer: 3 credits only.
List other courses, if any, that you plan to take in the same semester as Practicum:
List courses (in Psychology or other fields) you have passed that are relevant to your Practicum:
LIST WORK or VOLUNTEER EXPERIENCES relevant to your Practicum:
With what age group do you wish to work in your Practicum?
(e.g., children, adolescents, adults, senior citizens.)
In what type of setting do you wish to perform a Practicum? Be as specific as you can.
(e.g., mental health, school, services for aging, criminal justice.)
In what geographic area do you wish to perform a Practicum?
Will you have a car to use during this Practicum? Yes No
Briefly list YOUR GOALS for performing a Practicum. What do you hope to do and learn? Be as specific as possible.
What are your plans after graduation from Bloomsburg University?