Services
Virtual Practicums
Remote Internship Supervision
Program Development
Consulting
International Volunteering
About
About Child Life United
Team
Programs
Virtual Child Life Practicum
International Practicums
Clinical Immersion
International Volunteer Placements
Past Programs Gallery
Applications
CLU Administrative Internship
Professional Guest Speaker Inquiry
Clinical Supervisor Application
Contact
Child Life United Together
Student Application - ALL SECTIONS ARE REQUIRED
Printable Application
Personal Information
Name
*
First
Last
State practicums/programs you are applying to in order of preference
*
Email
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Credentials
*
Professional Memberships
*
Documents
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
Official ACLP Documentation of Volunteer Hours OR Verification from Volunteer Supervisor
*
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
*
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 OR Volunteer experience ? 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
Services
Virtual Practicums
Remote Internship Supervision
Program Development
Consulting
International Volunteering
About
About Child Life United
Team
Programs
Virtual Child Life Practicum
International Practicums
Clinical Immersion
International Volunteer Placements
Past Programs Gallery
Applications
CLU Administrative Internship
Professional Guest Speaker Inquiry
Clinical Supervisor Application
Contact
Child Life United Together