Graduate Practicum Application
Please fill out the below application prior to your desired semester's deadline, listed on our website,
www.marcus.org/training
.
A current CV and letter of interest are required application pieces, to be attached where indicated below.
If this placement is for academic credit at your home university, please attach any practicum manuals, forms, or site requirements from your school where indicated below.
For questions or concerns, please contact the Training Office at training.MAC@emory.edu.
Applicant Information
First Name
*
Last Name
*
Street Address
*
City
*
State
*
Zip Code
*
Primary Phone Number
*
Email Address
*
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.
In a Master's Program
In a Doctoral Program
Master's Intern (capstone placement)
Doctoral Intern (capstone placement)
Postdoc Residency
Post-degree training
University or College
*
Major/Discipline
*
Graduation Date or Anticipated Graduation Date
*
Is this placement to be for academic credit?
*
Yes
No
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.
BCBA/BCBA-D
Advanced degree in psychology or a related field
Doctoral degree
Licensed Clinical Psychologist
Licensed Psychologist
Masters Degree
Ph.D.
Licensed Dietitian
LMSW
Other
N/A
Are you seeking BCBA or BCaBA supervision hours?
*
Please note, you must be enrolled in a BACB-approved course sequence to apply for independent fieldwork supervision. Minimum time commitments are required in order to receive supervision and may vary between clinics.
Yes - BCBA
Yes - BCaBA
No
Practicum Placement Availability
Date of Available Start
*
Spring Practicums begin mid-January/mid-February
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 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 BACB supervision)
Business and Finance
Characterization Research Core--Infant research
Clinical Assessment and Diagnosis
Clinical Informatics
Educational Science Research Core
Infant Toddler Community Outreach Program
Language and Learning (may include BACB supervision)
Occupational Therapy-FW L1 (requires related major)
Parent Training Clinic (RUBI Clinic or Brief Behavioral Intervention Clinic)
Pediatric Feeding Disorders Clinic
Public Health-describe interests in cover letter
Severe Behavior Treatment Clinic (may include BACB supervision)
Social Skills Camp (Summer Only)
Social Work-internship
Speech and Language Pathology (requires related major)
Rank-Orders
If you are interested in more than one of the options above, please rank-order your additional departments and/or clinics of interest.
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.
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.
Yes
No, not for academic credit
Send me a copy of my responses
Email address
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