SCO Application For Practicum CPS 7661 and Internship CPS 7681

School Counseling Application for Practicum / Internship
Submission Date

MonthDayYearHourMinutesAM/PM Option
Full Name

First NameLast Name
Panther ID Number:*
NO DASHES!!! exp. 999000999
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
HomeNumber

Area CodePhone Number
Other Phone

Area CodePhone Number
E-mail Address:*
GSU email address only!!
IMPORTANT

All School Counseling students will begin practicum in Fall semester 2016; Internship I will begin during the last 5 weeks of the Fall semester; and Internship II will begin in the Spring 2017 semester.
1. Please indicate if you hold a teaching certificate

YesNo
State
2. If you are presently teaching or working in a school, please indicate the name of the school.
3 Please indicate which semester and year you plan to graduate:
4. Which program are you in?

ElementaryMiddleSecondary
5. What School Systems are you interested in for placement? If you have specific schools in these systems, please list those schools as well.
System 1*
Possible Schools*
* I have read the information in the practicum/internship handbook for School Counseling. Any questions about the contents have been answered by the CPS Graduate Advisor or by a School Counseling Program faculty member.

* I understand that if I am qualified and accepted to begin the practicum/internship sequence, I will do so during the semester for which I applied. Should my plans change for any reason, I will immediately notify the CPS academic advisor and submit a Practicum Postponement form.

* I agree to purchase liability insurance for my two semesters of field-based experience and to complete a Criminal Background Check as required by the College of Education.
Should be Empty:

School Counseling Application for Practicum / Internship