Illinois School of Professional Psychology
Argosy University, Schaumburg Campus
Advanced Practicum Registration
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Name:
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Last 4 Digits of Social Security Number:
Email Address:
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Telephone Number:
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Street Address:
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City:
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Please note that you may not complete this form until you have permission from the seminar instructor. In addition, please note that the expectation for students registering for 1.5 credits is 10 or less on site work and 7.5 contact hours with the seminar instructor per term. For students registering for 3 credits, students must be on site between 10-20 hours and must have a minimum of 15 contact hours with their seminar instructor per term.
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Registration For:
Advanced Practicum
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Instructor
Other
Carnazzo
Dodzik
Dugo
Eme
Goldman
Juzwin
Kukoleck
Lema-Stern
Mahoney
Mirman
Rastogi
Wasner
Instructor (other):
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Semester
Fall 2012
Spring 2013
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Number of Credits:
1.5 - I will be on site 5-10 hours per week
3 - I will be on site 10-20 hours per week
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Please Describe the nature of your Practicum. This should include location and number of hours per week (where applicable).
Office Use Only
Signature of Department Head
Signature of Instructor
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Indicates Response Required