Practicum Application

Your Personal Information

Your Name(Required)

First Last

Student ID(Required)

Minor(s) if applicable

Carleton Email Address(Required)

Enter Email Confirm Email

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

More About You

Please answer each question in this section thoughtfully and accurately.

1. What are your career goals?(Required)

2. In what ways do you hope to benefit from this practicum?(Required)

3. What type of placements are you most interested in?(Required)

At what type of agencies, and with what kinds of duties? If you have a specific placement in mind, please indicate as much as you can.

4. Can you think of any challenges that being in this placement will pose? If yes, what are your plans for coping with those challenges?(Required)

5. Do you have any occupational, educational, volunteer, or life experiences which we should consider?(Required)

6. Do you have any other comments concerning your situation, standpoint, qualifications, etc.?(Required)

References

In a placement, you would be a representative of Carleton University in the community. Please indicate the names, positions, phone numbers, work addresses and e-mail addresses of two non-family references for us to contact. Academic/professional references are ideal.

Referee #1(Required)

First Last

Position

Organization/Affiliation

Phone(Required)

Email(Required)

Referee #2(Required)

First Last

Position

Organization/Affiliation

Phone(Required)

Email(Required)

CHST 3905: Service-Learning in Community Settings – Practicum Application

Your Personal Information

More About You