Practicum Application

Practicum Application

Please fill out the below application prior to your desired semester's deadline, listed on our website, https://www.marcus.org/autism-training/educational-programs A current CV and letter of interest are required application pieces, to be attached where indicated below. If this placement is for credit, please attach any practicum manuals, forms, or site requirements from your school where indicated below. For questions or concerns, please contact Dr. Joanna Lomas Mevers at joanna.lomasmevers@choa.org.

Applicant Information

First Name*

Last Name*

Email Address*

What term is this application for?*

Multi-select; please select all terms this application is for.

Select

Street Address*

City*

State*

Zip Code*

Primary Phone Number*

Are you employed by any of the following?*

Children's Healthcare of Atlanta

Emory University

Emory Healthcare

None of these

Previously have you participated in training opportunities at Marcus Autism Center?*

(practicums, observations, elective rotations, etc.)

Yes

No

Previously have you participated in CHOA training?*

Yes

No

Previously have you volunteered at MAC or CHOA?*

Yes

No

If yes to any of the above 3 questions, where?

CHOA Egleston

CHOA Scottish Rite

CHOA Hughes Spalding

CHOA Neighborhood location

Marcus Autism Center- Severe Behavior

Marcus Autism Center-Language and Learning

Marcus Autism Center-Pediatric Feeding Disorders

Marcus Autism Center-Clinical Assessment and Diagnostics

Marcus Autism Center-Research Core

Marcus Autism Center-Other

Additional Training or Volunteer Sites

If you have trained or volunteered at more than one of the CHOA or MAC sites listed above, please list additional sites below.

Educational Background and Information

Education Level*

Please select your current degree program. If not currently enrolled, please select your highest level of education.

Professional/CE

High School

Undergrad

Post-bacc

Master's Program

Doctoral Program

Master's Intern

Doctoral Intern

Postdoc Resdiency

University or College*

Major/Discipline*

Graduation Date or Anticipated Graduation Date*

Is this placement to be for academic credit?*

Select or enter value

If yes, total # of training hours required?*

If this placement is not for academic credit, please enter N/A.

If yes, are there supervisor requirements?*

(specific education level needed, licenses and/or credentials) If this placement is not for academic credit, please enter N/A.

Select or enter value

Practicum Placement Availability

Date of Available Start*

Date Required for Completion*

minimum of 12 weeks required for most placements

Weekly Hour Availability*

For most placements, preference is given to candidates able to commit 12-15 hours a week.

less than 12

12-15

16-20

20 or more

Weekly Availability

Please check the days and times you are available to be at the Center for a practicum placement. Client hours are from 8:30am-4:30pm and all placements require trainee availability to be within these hours.

Monday Availability*

Please list the times of the day you are available for training at the Center.

Tuesday Availability*

Please list the times of the day you are available for training at the Center.

Wednesday Availability*

Please list the times of the day you are available for training at the Center.

Thursday Availability*

Please list the times of the day you are available for training at the Center.

Friday Availability*

Please list the times of the day you are available for training at the Center.

Availability Notes*

Please use this space for additional information about your weekly availability.

Placement Interest

Please mark the placement you are MOST interested in. If you are would like to be considered for multiple placement options, please use the space below to rank-order your interest.

Placement Options*

Behavior Analysis Research Core (no BCBA supervision)

Infant research

Clinical Informatics

Infant Toddler Community Outreach Program

Complex Behavior Support Program

Camp You be You (one-week sleepaway camp) *Graduate level applicants only*

Multidisciplinary Feeding Clinic

Skill Acquisition Program

Rank-Orders

If you are interested in more than one of the options above, please click on additional departments and/or clinics below in order of your interest. *Please note that if any program is not listed as a Placement Option above, then that program is not taking students for the upcoming term/semester.

Select

Reference #1 (other than family)

Reference #1 Phone Number

Reference #1 Email Address

Reference #1 Relationship to Applicant

Reference #2 (other than family)

Reference #2 Phone Number

Reference #2 Email Address

Reference #2 Relationship to Applicant

Reference #3 (other than family)

Reference #3 Phone Number

Reference #3 Email Address

Reference #3 Relationship to Applicant

Document Upload

Please upload the follow documents: 1. Current CV or Resume 2. Letter of Interest 3. If this placement is for academic credit, please attach any practicum manuals, site requirements, site supervisor forms, MOUs etc. required for credit by your school.

Additional Application Materials.*

Please upload a copy of your current CV and a letter of interest. If this placement is for academic credit, please also attach any practicum manuals, site requirements, site supervisor forms, etc. required for credit by your school.

Drag and drop files here or

I have attached my current CV

I have attached my Letter of Interest

For credit only*

I have attached all documents and manuals from my college or university describing the requirements for the practicum site and practicum experience.

Select or enter value

Camp Offer

Select or enter value

Are you seeking BCBA supervision

Select or enter value

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