Child Life Practicum Application
Name: _______________________________________________________
Address: _____________________________________________________
__________________________________________________________
Email: _____________________________________________________
Phone: _______________________________________________________
Emergency contact:____________________________________________
Relationship:_____________________ Phone: ____________________
Applying for:
____Spring term- November 1st deadline
____Summer term- March 1st deadline
____Fall term- July 1st deadline
To start by _________ and end by__________ with _______hours per week.
What will be your availability during the week to participate in the
practicum? (for example, MWF 9am – 5pm, TTh 2pm – 6pm)
_____________________________________________________________
_____________________________________________________________
On a separate page, please respond to the following questions:
How did you learn about Child Life?
What do you expect to gain from the practicum experience?
What other obligations will you have during your practicum (work, school,
etc.)?
Please return application to: IU Health North Hospital,
11700 North Meridian Street, Child Life- Rm B470, Carmel, IN 46032
Program Description:
It is the philosophy of the Child Life Program to seek the most highly
motivated and highly qualified practicum candidates. The practicum student
will increase knowledge of child life through observation and supervised
participation. The student who successfully completes this educational
program will have a basic understanding of the child life specialist as part of
a multidisciplinary team and the impact they have on children and families
in a healthcare setting.
Housing, transportation, parking expenses and meals are the responsibility
on the intern. IU Health North Hospital will provide the intern with a health
screening and criminal background check free of charge.
Entrance Requirements:
1. Must be working towards a career in child life, enrolled in a degree
program for child life, child development, or related field with strong
emphasis on development
2. High academic achievement- GPA 3.0 (B average)
3. Volunteer Experience (100 combined hours, minimum of 50 in a
healthcare setting)
- experience with physically well children
- experience with hospitalized children
4. Ability to commit to minimum of 100 hours (over the course of a 1012 week practicum observation experience supervised by a Certified
Child Life Specialist)
5. Ability to pass a mandatory health screening and background check
Application Process:
Individuals meeting the minimum entrance requirements may submit an
application to the Child Life Department. A complete application must
include the following:
1. Child Life practicum application
2. A current college transcript indicating cumulative GPA (can be a
copy)
3. Professional resume
4. Three recommendation letters (may use attached form)
5. Verification form for the required 100 hours of volunteer experience
must be complete at the time your application is received
Goals and Objectives for Practicum:
• To become familiar with the Child Life profession
• To gain understanding of the impact of hospitalization on the
emotional and developmental needs of children from infancy to
adolescence
• To have the opportunity to build rapport with patients on a one-to-one
basis and in group situations
• To gain a basic knowledge of medical procedures, terminology, and
the roles of multidisciplinary professionals within the hospital setting
• To provide opportunities to observe and explore theory and
intervention related to Child Life practices
• To learn general playroom management (safety, selection of toys,
craft materials, maintaining supplies/materials, etc.)
Practicum Requirements:
Educational
1. A 2-4 page paper will be required, addressing the impact of Child Life
interventions on a patient and family
2. Introduction to Child Life modules
3. Maintain a weekly journal
Clinical Development
1. Plan and implement developmentally appropriate play interactions for
children of all ages, both on an individual and group basis
2. Observe patient education and procedural support
3. Observe and participate in support of parents and siblings
4. Increase knowledge of medical terminology
5. Increase knowledge of coping and stress reduction techniques
Professional Development:
1. Meet with practicum coordinator
2. Formal evaluation will be completed at the completion of the
practicum program
Student Practicum Recommendation Form
Applicant’s Name ___________________________________
Date _____________
The above individual has applied for acceptance into the
Child Life practicum program at IU Health North Hospital.
Outstanding
Above
Average
Average
Below
Average
Weak
Maturity
Problem Solving Skills
Ability to accept guidance and supervision
Functions responsibly and independent
Motivation to learn
Interpersonal skills with adults
Interpersonal skills with children
Communication skills: written
Communication skills: oral
Dependability
Please share with us why you are recommending this individual for the Child Life Student
Practicum Program. What contributions do you feel he/she will make during this experience?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name __________________________
How long have you
known this applicant?__________________
Institution ______________________
In what context? ______________________
Position ________________________
May we contact you for further
information? _________________________
Phone # ________________________
Return recommendation form in a sealed/signed envelope to applicant
or return via e-mail to jmille25@iuhealth.org
Student Practicum Verification Form
for Supervised Hours Working with Children
Date: ________________
I confirm that ________________________________________________has completed
________________hours at ________________________________________________
working with children.
The applicants experience consisted of the following experiences (list typical types of
interactions with children, age of children, etc.):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Signature/Title: ___________________________________________
May we contact you for additional information? _________________
Phone number: ___________________________________________
Return verification form in a sealed/signed envelope to applicant
or return via e-mail to jmille25@iuhealth