Preliminary Application to Enroll in CSC Practicum

CSC Practicum

The purpose of this preliminary application is to initiate the process for securing a practicum placement as part of the MACSC program or as part of a CS specialization in another program. The CSC Practicum provides an opportunity for students to develop professional skills in a supervised setting, meeting the MACSC program's academic and experiential requirements.

Please Note: Submission of this preliminary application does not guarantee approval to begin a practicum. MDC reserves the right to evaluate academic performance, professional readiness, and personal suitability before granting permission to proceed. Placements must meet MDC criteria and require final approval from the program faculty.

Personal Information

Name(Required)
MM slash DD slash YYYY
Address(Required)

CSC Practicum Information

Please briefly identify the vocational goal that your CSC Practicum needs to serve (e.g., Chaplaincy, Pastoral Counselling, Psychotherapy, Social Work, etc.)
Please briefly identify all, if any, certifications you intend to pursue upon completion of your degree/practicum (e.g. CASC, CRPO, or equivalent).
Enter the term in which you wish to begin a CSC practicum. NOTE: Outside of rare and exceptional circumstances, a CSC practicum cannot begin less than two terms after the term in which the application is submitted. Applications must be received by the course add/drop date to be considered received in that term. Applications received after the add/drop date will be considered in the following term.

Academic Information

Educational History(Required)
School
Degree/Program
Graduation Year
 
Please list each post-secondary degree you have completed. Use the "+" button to add additional rows.
Prerequisites Completed or will Be Completed Prior to Practicum(Required)
Please select the courses you have already successfully completed as well as courses for which you have registered in the upcoming terms) and that will be completed prior to your desired practicum start date. NOTE: All courses from this list must be completed with a minimum GPA of B before a CSC Practicum can be started.
Previous Practicum Education
Teaching Center
CASC Approved (Yes/No)
Supervisor
CPE or PTE
Basic or Advanced
Year Completed
 
Please identify any practicum placements you have completed in the past. Use the "+" button to add additional rows.

Professional Information

Employment History(Required)
Position
Employer
Dates
 
Please list all professional employment held in the last 10 years. Enter "NA" if you do not yet have employment history to report. Use the "+" button to add additional rows.

Acknowledgement

Consent(Required)