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
Summer 2023 Virtual Practicum Student Application
CLU Administrative Internship
Professional Guest Speaker Inquiry
Clinical Supervisor Application
Contact
Child Life United Together
Virtual Practicum 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)
*
Indicates required field
Cover Letter/ Statement of Interest
*
Max file size: 20MB
Resume/ Curriculum Vitae
*
Max file size: 20MB
Eligibility Document (through ACLP) OR Proof of Completing Course Work (CLU accepts unofficial transcripts)
*
Max file size: 20MB
Documentation of Volunteer Hours OR Verification from Volunteer Supervisor (This can be the ACLP form or a professional statement on any organizational letterhead)
*
Max file size: 20MB
Two Letters of Recommendation are required for your application to be considered.
Please have your references email your recommendation letters to
childlifeunitedVP@gmail.com
with your name in the subject line
.
We will also allow you (as the applicant) to submit the recommendation letters if you have them in your possession from previous applications
(please email to
childlifeunitedVP@gmail.com
with your name in the subject line).
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
Use the space below to state the highest level of education (in process or completed).
University Name
*
Graduation Date or Anticipated Graduation Date
*
GPA overall / GPA major
*
Major
*
Degree's
*
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
COMMENT: Please list all additional Academic Institutions and degrees
*
By the start of the practicum 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 start of the virtual practicum.
*
Yes
No
By the start of the practicum will you have completed at least one child development course? This is a prerequisite and must be completed prior to the start of the virtual practicum.
*
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 well child 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
*
Additional 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
What have you done to increase your knowledge/ awareness of this profession?
*
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?
*
Financial Assistance
Do you require financial assistance?
*
Yes
No
If you choose yes to this question, please copy and paste the following link into another tab on your browser. Please ensure to submit the current practicum application prior to moving onto the google form which is our needs based scholarship application. *Note- the scholarship application is also due on 3/31
https://forms.gle/XFuRyEJx5Nz2T9rs6
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
Summer 2023 Virtual Practicum Student Application
CLU Administrative Internship
Professional Guest Speaker Inquiry
Clinical Supervisor Application
Contact
Child Life United Together
