North Dakota State University Counseling Center
Application for Graduate Student Position
Please submit this form, along with your résumé and a cover letter, either by completing and
attaching in an email to: Marlys.Borkhuis@ndsu.edu; or printing out, completing, and mailing
to:
Marlys Borkhuis
NDSU Counseling Center
P.O. Box 5226
Fargo, ND 58105
Name:
Current Address:
Permanent Address:
Phone Number:
Cell Phone Number:
Email Address:
In what graduate program are you enrolled?
What courses have you taken (up to this time) in your program?
What courses will you be taking next year?
Please provide the name, title, phone number and email address of someone who knows
your work in a previous internship/practicum/fieldwork setting (such as a previous practicum
advisor or supervisor). Please note that this and/or other references may be checked at our
discretion:
Does the type of placement you are seeking best fit into the category of practicum,
internship, fieldwork, or some other category?
How many hours does your program require that you spend it your
internship/practicum/fieldwork experience?
Does your on-site supervisor need to have a specific licensure? If so, what licensure would
that be?
Are you aware at this time of any time commitments that you will have next year that will
need to be met (during weekdays from 8-5) and therefore, you could not be in the office at
that time? Any information that you can offer is helpful as we look to next year’s scheduling
of graduate students.
What clinical counseling practical experience have you had? Please elaborate:
What practical experience have you had providing “helping” services? Please elaborate:
Thank you for applying for a student training position
at NDSU Counseling Center!