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Completed advanced practicum application
Completed advanced practicum application
Completed advanced practicum application
Completed advanced practicum application
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Completed advanced practicum application

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  • 1. Advanced Practicum Application After completing please give this to a supervisor to fill out the last pageName (please print): ______________________________________TA at Croyden (circle one): Joe Brighid Dru KellySemester enrolled in PSY 357: ______________________________Child/children worked with: _________________________________Current grade in PSY 357: __________________________________Semester interested in the Advanced Practicum: Summer ‘11 Fall ‘10 Spring ’11 o I am aware as an Advanced practicum student I will be required to: o Attend Woodsedge 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 gainfrom the experience What qualifications do you have? Why do you deserve anopportunity over other applicants and what contributions can you make to thepracticum?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
  • 2. Are you interested in graduate school at Western Michigan University?Not interested 1 2 3 4 5 Very interestedHow 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 CONTACTYOU BETWEEN SEMESTERS.Email Address (please print clearly):_____________________________________________Phone Number: ________________________________Local Address: _____________________________________________________________________________________________________________________________Permanent Address: _________________________________________________________________________________________________________________________
  • 3. Advanced Practicum Application(Applicant: Please give this to your monitoring supervisor (the one who monitors you at Woodsedge) Supervisors must return toName of applicant: ______________________________________Child/children worked with: _________________________________Number of absences at Croyden: _____________________________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, TAs, and Croyden Staff? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 4.) What stands out about the applicant (either positive or negative)? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 5.) Please provide comments regarding the student’s interpersonal skills?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
  • 4. 6.) What stands out about the applicant (either positive or negative)? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Recommendation for the Advanced Practicum: [Very strongly] [Recommend] [Recommend with reservations] [Do not] Please rate the student’s skills below: Not Able to5 being the best and 1 being the worse 1 2 3 4 5 JudgeIntellectual/Critical Thinking AbilityKnowledge of Chosen FieldMotivation/Demonstrated InitiativeResearch PotentialTeaching PotentialSocial SkillsWork HabitsOriginality/Creativity/Innovative ThinkingProblem Solving/Abstract Reasoning AbilityOral Communication SkillsWritten Communication SkillsLeadership PotentialEmotional Stability/Personal Maturity/Evaluation of SelfProfessionalism Under Stressful SituationsOpenness to FeedbackAcceptance of ResponsibilityAbility to Work Independently

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