Additional Practicum Registration Request

Students interested in completing additional practicum courses outside of ADST 5P74/5P76, please complete the Additional Practicum Registration Request form.

If you are an MA student wishing to take additional practicum courses (ADST 5P21-26), please fill out this form to request registration approval. Without this form being completed you will not be able to register for any additional practicum courses. Please be sure to seek the approval from your Thesis Supervisor before filling out this form.

This form is to be completed NO LATER THAN 4 WEEKS PRIOR to the start of each term.

  • Name * Required
  • Thesis Supervisor Name * Required
  • Has your Supervisor Approved Your Practicum Placement? * Required
  • Have you confirmed a practicum placement site? * Required
  • If you have confirmed your placement site, please indicate the name and address of the Agency.
  • Agency Address
    If you have confirmed your placement site, please indicate the name and address of the Agency.
  • Is this your current employer?
  • Is this an unpaid volunteer practicum?
  • All students must complete 150 hours per practicum. Hours per week will be between 10 and 30. Please indicate the hours per week you estimate to be working.
  • Field Supervisor Name
  • BCBA Supervisor Name
    Your BCBA Supervisor may be the same as your Field Supervisor.
  • Please indicate if your BCBA Supervisor is Internal or External to the Agency
  • This field is for validation purposes and should be left unchanged.