Graduate Student Placement Application Name* First Last Field of Study*Applied Behavior AnalysisOccupational TherapyPhysical TherapySpeech-Language PathologyEmail* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Graduate School* How many placements have you already completed?*01234If offered an interview, are you willing to travel to our office in Chicago?* Yes No Does your school already have an affiliate agreement in place with Chicago Kids Therapy?* Yes No Placement Coordinator Contact InformationName* First Last Email* Phone*Dates of PlacementAnticipated Start Date (Month)*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberAnticipated Start Date (Year)*2019202020212022Short EssaysTell us about yourself and why you are interested in our program for your placement.*Tell us a little bit about your interest in the field. What are you passionate about?*Tell us a little bit about your interest in the field. What populations are you interested in working with after graduation?*File UploadsResume*Max. file size: 50 MB.Video*Max. file size: 50 MB.Include a video with your application here. Don't worry, you don't need to be Steven Spielberg. Let your unique personality shine by telling us about your background experiences and why you are interested.
