Child Life and Education’s Practicum Guidelines and Requirements: Thank you for your interest in the Child Life and Education Program at The Children’s Hospital at MetroHealth Medical Center! We are proud of our long established Child Life and Education Program, started by the legendary Emma Plank in 1955. Our program serves inpatient and outpatient areas including but not limited to Pediatric Intensive Care, Burn Intensive Care, Urgent and Well-Child Clinics. Qualified practicum applicants must have: Completed a minimum of 75 hours of volunteer experience working with pediatric patients in a hospital setting. Be enrolled as a student in a child life degreed program. Our practicum program offers: 128 hour practicum experience Shadow and observation opportunities in all areas of coverage provided by the Child Life & Education Department Qualified applicants need to: Complete the practicum application Enclose two letters of recommendation (one letter from a clinical CCLS) Enclose school transcripts Enclose recorded volunteer hours from hospital(s) Only qualified practicum applicants will be contacted for an interview. METROHEALTH MEDICAL CENTER CHILD LIFE AND EDUCATION PROGRAM Student Practicum Application Please Print Full Name: ______________________________________ Date of Application: ____________ Current Address: _______________________________________________________________ Permanent Address: ____________________________________________________________ Phone No.: ____________________ Indicate Best Time(s) To Call: ______________________ Email address:_________________________________________________________________ Contact Person (For Message/Emergency): __________________________________________ Contact Person Phone No.: _________________ Relationship To Contact Person: ___________ Major: _______________________________________________________________________ Currently Student or Graduate of (University or College): _______________________________ Graduate Student of (University or College): _________________________________________ Expected Graduation Date and Degree: _____________________________________________ Supervisor/Advisor Name and Title: ________________________________________________ Supervisor/Advisor Phone No.: ____________________________________________________ Dates Preferred For Placement: ____________________________________________________ Describe Any Schedule Considerations or Limitations Below: ______________________________________________________________________________ 1. Previous or Current Experience with Children (in a hospital setting) a. Site: _______________________________ Dates: _____________________________ Total Hours: _________________________ Ages of Children: _______________________ Description of Experience: ____________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ b. Site: ____________________________ Dates:_________________________________ Total Hours: __________________________ Ages of Children: ______________________ Description of Experience: ____________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ c. Site: _________________________________ Dates: ____________________________ Total Hours: __________________________ Ages of Children: _____________________ Description of Experience: ____________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 1. Describe in your own words, your personal philosophy of Child Life: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. List your personal/professional goals for your practicum experience: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ Send Completed Application To: Erin Whipple, MA, CCLS MetroHealth Medical Center Child Life and Education Program, H-407 2500 MetroHealth Drive Cleveland, Ohio 44109 Phone Number: 216-778-2959 Revised: 9/06, 7/08, 1/11, 2/12, 9/13