About
About Child Life United
Team
Programs
Virtual Child Life Practicum
International Programs
Past Programs Gallery
Applications
Puerto Rico Student Application
Contact
Puerto Rico Student Application - ALL SECTIONS ARE REQUIRED
Personal Information
Name
*
First
Last
Email
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Credentials
*
Professional Memberships
*
Documents
(ALL DOCUMENTS MUST BE SUBMITTED IN PDF FORMAT TO BE ACCEPTED)
Cover Letter/ Statement of Interest
*
Max file size: 20MB
Resume/ Curriculum Vitae
*
Max file size: 20MB
Eligibility Document OR Proof of Completing Course Work
*
Max file size: 20MB
Professional Reference Letter #1
*
Max file size: 20MB
Professional Reference Letter #2
*
Max file size: 20MB
Emergency Information
Emergency Contact / Relationship
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Languages
Primary / 1st Language
*
other languages and degree of skill (Learning, Basic, Fluent)
#1
*
#2
*
#3
*
Academic Information
Please list all colleges/ universities.
If additional space is needed use comment box.
University Name
*
Major
*
Years attended/ Graduation
*
GPA overall / GPA major
*
Degree's
*
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
COMMENT: List additional Academic Institutions
*
*
Indicates required field
By the start of the pre- internship experience will you have completed the required introductory child life course taught by a CCLS? This is a prerequisite and must be completed prior to the program start date.,
*
Yes
No
By the start of the pre-internship experience will you have completed at least one child development course? This is a prerequisite and must be completed prior to the start of the program.
*
Yes
No
EXPERIENCE WITH CHILDREN, YOUTH OR FAMILIES
Healthcare Setting
Please list all healthcare experiences (volunteer, practicum student). If additional space is needed use comment box.
Institution Name
*
Title (e.g volunteer, practicum student)
*
Supervisor's Name/ Credentials/ Title
*
Supervisor's Phone Number
*
Dates mm/yr
*
Hours/Week
*
# of Weeks
*
Total Hours
*
Briefly describe population and responsibilities
*
Experience with Children, youth or families
Stressful situations
Please list all stressful situation experiences (camps for children with chronic illness, programs for children with special needs, advocacy programs, bereavement/ hospice).
Institution Name
*
Title (e.g. volunteer, practicum student)
*
Supervisor's Name/ Credentials/ Title
*
Phone Number
*
Dates mm/yr
*
Hours/ Week
*
# of Weeks
*
Total Hours
*
Briefly describe population and responsibilities
*
Experience with Children, youth or families
Well Child
Please list all stressful situation experiences (nanny, counselor, teacher).
Institution Name
*
Title (e.g. volunteer/ practicum student)
*
Supervisor's Name/ Credentials/ Title
*
Phone Number
*
Dates mm/yr
*
Hours/ Week
*
# of Weeks
*
Total Hours
*
Briefly describe population and responsibilities
*
Additonal Work Experience
Institution
*
Title (e.g volunteer/ practicum student)
*
Supervisor's Name/ Creditionals/ Title
*
Phone Number
*
Dates mm/yr
*
Hours/ Week
*
# of Weeks
*
Total Hours
*
Briefly describe population and responsiblities
*
Essay Questions
Why are you interested in an international Child Life Practicum? Have you ever been out of your home country
*
What have you done to increase your knowledge/ awareness of this profession?
*
Briefly describe the ways in which the work of a Child Life Specialist contributes to the health care experience of a child and their family.
*
Provide a specific example of a time that you used play to meet the developmental needs of a child.
*
Is there any additional information you would like to share?
*
by electronically submitting your name you attest that this application is true and accurate to the best of your knowledge - SIGN HERE
*
Submit
About
About Child Life United
Team
Programs
Virtual Child Life Practicum
International Programs
Past Programs Gallery
Applications
Puerto Rico Student Application
Contact
