Almost Home KidsChild Life Practicum Application

Today’s Date:

Semester Applying for: Fall Winter/Spring Summer(please circle)

Location Applying for: Naperville Chicago No Preference(please circle)

Full Name: First Middle Last

Permanent Address: Street Apt/Unit #

City State Zip Code

Primary Phone Number:

Alternative Phone Number:

Email Address:

Are you under the age of 18? Yes No Do you speak/are you fluent in any language other than English: Yes No If Yes, please specify:

Application Category:Non-Affiliated/Independent Affiliated/School Credit

If University/College Affiliated:Sponsor/Advisor Name:

University/College Name:

School Address:

Advisor’s Email:

Advisor’s Phone Number:

Previous/Current Volunteer and/or Practicum Experience:

Institution Location Hours Completed

Date(s) Supervisor Name Supervisor Contact Phone Number

Institution Location Hours Completed

Date(s) Supervisor Name Supervisor Contact Phone Number

Institution Location Hours Completed

Date(s) Supervisor Name Supervisor Contact Phone Number

College Education:

Institution Major/GPA Graduation Date

Institution Major/GPA Graduation Date

Institution Major/GPA Graduation Date

Please send completed application to:Almost Home Kids-Naperville Attn: Katie Kass, CCLSChild Life Services 7S 721 Route 53 Naperville, Illinois 60540

Almost Home KidsChild Life Practicum Application Check List

In order to be considered for a Child Life practicum placement, the following application materials must be included:

Completed Almost Home Kids application. 300 word essay (maximum) to each of the following questions:

1. Describe how you got interested in Child Life. 2. Why do you want to complete a Child Life practicum at Almost

Home Kids? 3. You are newly introduced to a 3 year old patient who is non-verbal.

What materials do you choose to engage in play to promote optimal development? How do you communicate? Please describe why you chose the materials/activities (can be a maximum of 500 words).

List of professional goals you wish to accomplish during your Child Life Practicum experience at Almost Home Kids.

Resume, including total number of hours completed for any current or previous volunteer/practicum experience.

2 letters of recommendation. Letters must be signed and sealed in envelope.

Transcript (can be unofficial) Coursework (minimum of 4 college level courses) in related field of Child

Life such as family studies, child/human development, education, introduction to Child Life, etc. Must be completed or in the process of completing.

A minimum of 50 hours of direct experience with well children (50 hours must be completed at time of application submission).

A minimum of 50 hours of direct experience with sick children in the hospital setting (50 hours must be completed at time of application submission).

Signed application checklist.By signing this Application Check List, I confirm that the information I provided is true and to the best of my knowledge. Any false statements is cause for rejection or immediate discharge when discovered.

Applicant’s Signature: Date: