CHILD LIFE PRACTICUM APPLICATION
All applicants must be enrolled in a college/university/academic program and receiving credit hours for the practicum.
Contract between the hospital and school will need to be negotiated prior to start of practicum. School must supply worker’s compensation and general liability insurance for student activities and education. Student or school must provide proof of professional liability insurance.
PERSONAL INFORMATION
Name
Mailing Address City State ZIP Code
Permanent Address City State ZIP Code
Telephone Alternative Telephone
Email Address
Please check box for which address we should mail communications to.
Mailing Permanent
ACADEMIC BACKGROUND
Current University/College
From To
Dates Attended (Month/Year)
Major Minor/Areas of Emphasis
Graduation Date Degree Earned Cum GPA
Past University/College
From To
Dates Attended (Month/Year)
Major Minor/Areas of Emphasis
Graduation Date Degree Earned Cum GPA
PRACTICUM PREFERENCE
Practicum applying for: Child Life
Desired practicum session: Summer 20
Will you be using the practicum to complete college credits? Yes No
Academic Advisor
Academic Advisor Phone Number
Academic Advisor Email
Academic Advisor Aware that contract is required? Yes No
SUPPLEMENTAL INFORMATION
Please include the following information with your application:
An unofficial transcript from each university/college you have attended.
A copy of your current resume
A completed Work/Volunteer Experiences Chart (located on website)
One letter of recommendation from your academic advisor. This letter should also include the statement “As the academic advisor I have received information on the contract from this applicant and am willing to advocate for university support to reach agreement on the contract.”
One letter of recommendation from an individual (other than relatives or friends) familiar with your work with children/families.
A typed response to the following:
1. A professional statement explaining why you are exploring a practicum at Children’s Hospital Colorado.
2. Please list 3 goals and objectives you expect to accomplish during your practicum.
3. In 50 words or less, what is a Child Life Specialist?
ACKNOWLEDGEMENT
I confirm that the information provided in the application is true to the best of my knowledge. I further understand that any false statements on the application shall be sufficient cause for rejection for this practicum or immediate discharge when discovered.
I hereby authorize my former supervisors and references to release information regarding my past experiences to assist this committee in determining my suitability for the practicum.
I understand that if I am selected as a practicum student, I am required to do the following before beginning my practicum.
Provide an official transcript
Provide proof of health insurance
Complete HR health screen requirements/tasks, due 2 weeks prior to the start date of practicum.
Complete a background check
Complete all required readings and activities prior to arrival
University/hospital contract signed 2 weeks prior to start.
Applicant’s Signature Date
Please return completed application and materials to: Tommi McHugh, MA, CCLS
Child Life Department
Children’s Hospital Colorado
13123 E 16th Ave Box 220
Aurora, CO 80045
Please direct any questions to 720-777-9159 or
Children’s Hospital Colorado practicum selection committee does not discriminate on the basis of race, color, religion, national origin, sex, age, veteran status or disability. We reserve the right to not offer the practicum every summer.