CHC Doctoral Psychology Student Practicum Application
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Application for CHC Doctoral Psychology Student Practicum

This application should take approximately 10 minutes to complete. Applicants need basic demographic and educational information. Required documents to upload include resume, cover letter and statement of interest in treating underserved populations, and the names and contact information for two references.
Once submitted, applicants cannot edit their application. Email psychologytraining@chc1.com with any questions.

General Information
 *
 *
 
Languages
List any languages spoken at a proficiency level to treat clients.
This includes English as primary or secondary language.

Proficiency levels are:
Professional: can speak in a structured manner with a broad vocabulary and good application of the language's grammar.
Full Professional: can speak fluently in any conversation and is comfortable using language in session with clients.

Education
Patient Areas of Interest
Dual Therapy & Psychological Assessment
This Section is Optional

This dual placement is open to 3rd and 4th years only.
Placement will include therapy and assessments.
A sample assessment report is required if you elect to apply for this slot. Email the de-identified sample report to stpaulm@chc1.com. Be mindful to remove or cover any patient information (name, date of birth, etc).

 
 
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References
Provide the name and contact information for two professional references. After submitting your application, they will receive an email with a link to complete a reference form.
         
Professional Reference #1
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Professional Reference #2
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Application Attestation
I certify that the answers given in this application are true to the best of my knowledge.
I understand that the use of this application form does not indicate that there are any positions open and does not in any way obligate Community Health Center, Inc. to offer practicum placement.
I understand that should I be granted an interview, no representations that may be made at the interview are to be construed as creating any obligation, promise or contract on behalf of Community Health Center, Inc.
I understand that the lack of truthfulness, misleading information or material omissions given in my application, resumes, interview(s) or during the course of my practicum are grounds to terminate the practicum placement whenever they are discovered.
I understand that acceptance for practicum placement shall depend on satisfactory replies from my references and other background checks.
 
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