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

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.

University or College*

Major/Discipline*

Graduation Date or Anticipated Graduation Date*

Is this placement to be for academic credit?*

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.

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.

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.

Send me a copy of my responses

Email address

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