Florida Gulf Coast University
COUNSELING and PSYCHOLOGICAL SERVICES (CAPS)
Graduate Assistant Application
Fall 2016 – Spring 2017
Name: __________________________________ Date of application: __________________
Address: ____________________________________________________________________
UID#
__________________________
Phone: Daytime: ( _____ )_____________ Other Phone: (_____) _________
Email: _____________________________
Program: MA Mental Health Counseling ____ Master of Social Work ____ Other __________
What are your career goals?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
How do you envision CAPS meeting your training goals and interests?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Please briefly describe your experience: (population refers to what group, such as at-risk
teens, elderly, abused women, etc., in the Description please provide other relevant
information, like the title of the group or theoretical orientation. You may attach
additional description if needed):
Hours
Setting/agency
Population Description
Clinical
Intake/Evaluation
Individual Therapy
Group Therapy
Career
Assessments
Career Counseling
Mandated
assessment/therapy
Substance use/
Abuse
Outreach/education
programs
Any other clinical or relevant wellness related training, diverse populations, or special skills:
____________________________________________________________________________
____________________________________________________________________________
Describe your current philosophy and/or theory of the counseling process:
__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Semester you entered graduate program: ____________________, 20__.
Semester you intend to graduate: ______________ , 20__
.
My faculty advisor is: ________________________
My field placement supervisor (from my department) is ______________
Have you ever been convicted of, pled guilty to, or pled nolo contendre (no contest) to a
felony or legal offense that would influence your ability to perform in this agency?
(Example: sexually-based offenses, drug or alcohol offenses, domestic violence, or similar).
Have you ever had any disciplinary action taken against you for being in violation of
ethical/legal standards of practice by a graduate or internship training program,
practicum site or employer? Have you ever been sanctioned for any policy violation at
FGCU? Please explain. Answering yes to this question does not automatically disqualify you
from working at CAPS.
__________________________________________________________________________
__________________________________________________________________________
Please be aware that a criminal history background check, including fingerprinting, will
be performed for each trainee selected for our program. Final offers for applicants are
contingent upon successfully passing these background checks.
Apply by creating one email with the following documents:
 This application, electronically completed (do not handwrite and scan)
 A curriculum vita (a resume that includes a list of courses taken; please also list
courses you are enrolled in for fall 2016)
 Three professional references that we may check. Include full contact information
(name, address, phone number, e-mail address).
Email your completed application to Dr Laura Wright at lwright@fgcu.edu
APPLICATIONS ARE DUE BY 5 PM, Friday MARCH 11TH.