KAC AP application

395 views
257 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
395
On SlideShare
0
From Embeds
0
Number of Embeds
113
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

KAC AP application

  1. 1. Advanced Practicum Application After completing please give this to a supervisor to fill out the last page Name (please print): ______________________________________ Supervisor at KAC: _______________________________________ Semester enrolled in PSY 357: ______________________________ Child/children worked with: _________________________________ Current grade in PSY 357: __________________________________ Semester interested in the Advanced Practicum: Fall ’13 Spring ‘14 o I am aware as an Advanced practicum student I will be required to: o Attend KAC 10 hours a week. o Attend one-to-one meetings with assigned case coordinator and a BCBA supervisor to discuss assigned children. o Assist a case coordinator with many of the tasks involved in this position which will require additional hours beyond the onsite time. Briefly explain your interest in the advanced practicum. What do you hope to gain from the experience What qualifications do you have? Why do you deserve an opportunity over other applicants and what contributions can you make to the practicum? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ______________________________________________________________________ __________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
  2. 2. Are you interested in graduate school at Western Michigan University? Not interested 1 2 3 4 5 Very interested How interested are you in graduate training in behavior analysis? Not interested 1 2 3 4 5 Very interested PLEASE FILL OUT OTHER SIDE Questions or comments should be emailed to? at: WIN #:_____________________ Are you a BRSS student? ________ If yes, which system or project are you working on and who supervises you? ---------------------------------------------------------------------------PLEASE FILL OUT EVERYTHING SO THAT WE ARE ABLE TO CONTACT YOU BETWEEN SEMESTERS. Email Address (please print clearly): _____________________________________________ Phone Number: ________________________________ Local Address: _________________________________ ______________________________________________ ______________________________________________ Permanent Address: _____________________________ ______________________________________________ ______________________________________________
  3. 3. Schedule
  4. 4. NAME: EMAIL: PHONE: WIN: Practicum you're applying for (circle one): Intermediate Advanced Summer ____ Fall _____ Spring _____ Please fill in the cells when you are scheduled to be in class or at work. In the cell, please also include the exact start/end times. Monday Tuesday Wednesday Thursday Friday 8:00 Semester you plan on doing the practicum: 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00 *Remember you need to do 2 hours/day 5 days/week!! Please circle the shift(s) you are available for 5 days/week 8:00-10:00 10:00-12:00 12:00-2:00 2:00-4:00 Please list the names of the children you worked with:
  5. 5. Advanced Practicum Application (Applicant: Please give this to your monitoring supervisor the one who monitors you) Supervisors must return to Lauren DeClaire Name of applicant: ______________________________________ Child/children worked with: _________________________________ Number of absences at KAC: _____________________________ Please provide comments based on the applicants performance: 1.) Has the applicant been successful in implementing procedures with their child/children? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 2.) How does the applicant accept feedback? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 3.) How well does the applicant interact with Supervisors, other tutors or CDC Staff? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 4.) What stands out about the applicant (either positive or negative)? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 5.) Please provide comments regarding the student’s interpersonal skills? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
  6. 6. Recommendation for the Advanced Practicum: [Very strongly] [Recommend] [Recommend with reservations] [Do not] Please rate the student’s skills below: 5 being the best and 1 being the worse Intellectual/Critical Thinking Ability Knowledge of Chosen Field Motivation/Demonstrated Initiative Research Potential Teaching Potential Social Skills Work Habits Originality/Creativity/Innovative Thinking Problem Solving/Abstract Reasoning Ability Oral Communication Skills Written Communication Skills Leadership Potential Emotional Stability/Personal Maturity/Evaluation of Self Professionalism Under Stressful Situations Openness to Feedback Acceptance of Responsibility Ability to Work Independently 1 2 3 4 5 Not Able to Judge
  7. 7. Recommendation for the Advanced Practicum: [Very strongly] [Recommend] [Recommend with reservations] [Do not] Please rate the student’s skills below: 5 being the best and 1 being the worse Intellectual/Critical Thinking Ability Knowledge of Chosen Field Motivation/Demonstrated Initiative Research Potential Teaching Potential Social Skills Work Habits Originality/Creativity/Innovative Thinking Problem Solving/Abstract Reasoning Ability Oral Communication Skills Written Communication Skills Leadership Potential Emotional Stability/Personal Maturity/Evaluation of Self Professionalism Under Stressful Situations Openness to Feedback Acceptance of Responsibility Ability to Work Independently 1 2 3 4 5 Not Able to Judge

×