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Practicum Application

CAS 464: Undergraduate Practicum in Addiction Treatment or Prevention Services

Practicum Application

Accepting Applications (late applications will not be accepted)

Spring: November 1-15
Fall: March 1-15

Please select the practicum track and semester you are applying for:
Track*
- Addiction Treatment Services
- Prevention Service
Semester*
- Spring
- Fall
Year*
Student Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Primary Phone*
Major*
Anticipated Graduation Date*
Month
Day
Year
Employment Information
Employed*
- Yes
- No
Place of Employment*
Approximate Number of Hours Worked Weekly*
Job Description*
Is your place of employment flexible to your school schedule?*
- Yes
- No
Additional Comments Regarding Employment:
Preferred Setting, Population and/or Location for Placement
Population*
(i.e., Adolescents, Adults, Seniors)
Setting*
(i.e., Methadone Clinic, Criminal Justice, Hospital)
Preferred Site Location if Known:
(i.e., Quest, Alta-Vista, Children’s Cabinet)
Courses Completed
Have you completed CAS 354?*
- Yes
- No
CAS 354 Instructor*
When do you plan to complete CAS 354?*
Have you completed CAS 355?*
- Yes
- No
CAS 355 Instructor*
When do you plan to complete CAS 355?*
Have you completed CAS 454?*
- Yes
- No
CAS 454 Instructor*
When do you plan to complete CAS 454?*
Please explain your reasons for applying and what you hope to gain should you be selected to participate into the CAS 464 Practicum:*
(5-10 sentences)

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