Application for Coun238 Advanced Practicum
For Office Use only
Received by:______________
Date:____________________
Application for Coun238 Advanced Practicum
Practicum Location:
Fresno Family Counseling Center
5151 N Palm Ave Suite 200
Fresno, CA 93704
Phone (559) 229-3085
Please type and email back to fresnofamily@yahoo.com
Name:______________________________ Date:
Address:____________________________ Primary Phone:
City/Zip:____________________________ CSUF Student ID#
Email:______________________________ Languages Spoken
Coun 208, 230 and 232 are prerequisites for this course. You MUST have taken these
courses prior to applying to
C238. Coun 231 must be taken prior to or concurrently with Coun 238. Coun 231 is NOT
offered in the Summer.
1. Preferred Semesters:
[ ] Spring 2019 [ ] Summer 2019 [ ] Fall 2019
[ ] Spring 2020 [ ] Summer 2020 [ ] Fall 2020
[ ] Spring 2021 [ ] Summer 2021 [ ] Fall 2021
[ ] Spring 2022 [ ] Summer 2022 [ ] Fall 2022
[ ] Spring 2023 [ ] Summer 2023 [ ] Fall 2023
2. Are you a “Classified” Graduate Student?
[ ] Yes [ ] No
3. When did/will you take Coun 208 Practicum? __________________________
Who was/will be your instructor? __________________________
(Please note that your instructor may be contacted prior to admittance and that instructor
recommendation is required for Summer section.)
4. When did/will you take Coun 232 (DSM)? ____________________________
5. When did/will you take Coun 230 (Family Therapy Theories)? _______________________
6. When did/will you take Coun 231 (Ethics/Professional Practice)? ______________________
Please read and sign:
Enrollment in this course is limited and admittance is based on date of application,
Coun 208
instructor recommendation, and availability. You will be contacted by email at the
end of the
semester prior to being admitted. Upon admittance, you will be required to attend
a 3-day mandatory
training/orientation that is scheduled a week before the semester starts.
________________________________________________
Signature Date
This PDF is provided as a print-only reference document and may not be fully accessible to users of assistive technology. For more information, please visit Title II Rule on Digital Accessibility page.