Your advisor's signature is required on your application for Practicum. Either print off the PDF application and mail to your advisor for their signature, or have your advisor send the Community Counseling Services Director an e-mail in support of your application to enroll in Practicum. An e-mail from your advisor will serve as their signature. It is your reponsibility to have your application signed by your advisor.

Documentation providing evidence of Professional Liability Insurance coverage must be attached to this application. You will also need to bring an actual hard copy of your professional liability insurance certificate to your personal interview.

**Please paste a copy of your certificate of insurance in this text box**

I plan to complete my practicum experience at (check one):

**Please paste your unofficial transcript in this text box**

'"For Office Use Only"

Approval of Enrollment in Practicum for:

Date Student Notified of Approval: (dd/mm/year) By:

Your Application has NOT been approved. Please address the following:

Name and Date Student Notified: