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Family, Consumer, and Human Development

FCHD 4970 Gerontology Practicum Application

*Required

Personal Information
Education (List most recent first)
College 1
College 2
College 3
Work Experience (List most recent first)
Agency 1
Agency 2
Agency 3
 
Current Status
List gerontology certificate courses that you have completed, are currently enrolled in this semester, or that you will enroll in and complete prior to your practicum experience. Only list htose classes required for the gerontology certificate. NOTE: At least 12 gerontology credits must be completed prior to beginning practicum.
If you are currently working, what impact will this have on your availability to complete your practicum experience?
Semester and year of desired practicum experience: