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This form is to be completed by student no later than October 1st for a Spring semester practicum experience start, and no later than March 1st for a Fall semester practicum experience start.

    Statement of pre-requisite coursework for CG 591.

    Clinical Field Experience Setting Preference. Rate your 1st, 2nd, and 3rd choices:

    Re-order Grades K-4 Grades 5-8 Grades 9-12 Weight Operations
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    The School Counseling Program is a program of professional training designed for those who wish to acquire counseling knowledge and skills to apply in the school setting, K-12. Although applicants for practicum and internship will not necessarily be precluded from admission based on prior criminal conviction, they are advised that the Ohio Department of Education may refuse to issue a license to an individual with a criminal record. Have you ever been convicted of, found guilty of, pled guilty or no contest to any crime other than a minor traffic violation?
    Are you currently using illegal drugs or substances or abusing alcohol or other legal drugs?
    Certification
    By checking the "yes" box above I certify the information I have provided is accurate and complete. I understand that falsifying or omitting information is grounds for immediate dismissal from the School Counseling Program and John Carroll University.