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Psychology Practicum Application

1. Applicant Information

Home Address
Business Address
Preferred Mailing Address

2. Institution

3. Training Opportunities

Please rank in order of preference only those areas of interest
Includes: Outpatient General Adult Track, Borderline Personality Self-Regulation Clinic, The Traumatic Stress Clinic

4. Psychological Assessment Experience

List below all the psychological assessment instruments you have experience in: administration, scoring, and interpretation.
Domain: Cognitive, Intellectual
Domain: Memory
Domain: Neuropsychological
Domain: Personality
Domain: Structured Clinical Interview
Domain: Symptom Rating Scales
Domain: Depression/Anxiety
Domain: Risk Assessment Forensic

Wechsler Adult Intelligence Scales (WAIS-IV)

Wechsler Intelligence Scale for Children (WISC-V)

Wechsler Individual Achievement Test (WIAT-III;IV)

Wide Range Achievement Test (WRAT 4; 5)

Wechsler Memory Scales (WMS-III; IV)

Delis-Kaplan Executive Function Scales (D-KEFS)

Halstead-Reitan Battery

Kaplan Process Battery

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

California Verbal Learning Test (CVLT)

Minnesota Multiphasic Personality Inventory - Restructured (MMPI-2-RF)

Personality Assessment Inventory (PAI)

Personality Assessment Inventory - Adolescent (PAI-A)

Millon Clinical Multiaxial Inventory (MCMIV)

Structured Clinical Interview for DSM-5

Structured Clinical Interview for DSM-5- Personality Disorders (SCID-5-PD)

Kiddie-Schedule for Affective Disorders (K-SADS) for DSM-5

Children's Behavioural Checklist (CBCL)

Positive and Negative Symptoms Scale (PANSS)

Trauma Symptom Inventory (TSI)

Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5)

Beck Depression Inventory (BDI-II)

Beck Anxiety Inventory (BAI)

Historical Clinical Risk Guide (HCR-20 V3)

Psychopathy Checklist Revised (PCL-R Revised 2nd Edition)

Risk for Sexual Violence Protocol (RSVP)

Please list other tests that you have experience with that do not appear above

Other Test (A)
Other Test (B)

5. Clinical Treatment Experience

Please indicate the number of clients you have seen in each column according to treatment modality, individual versus group and length of treatment
Select the treatment modalities you have used with clients in group or individual treatment.

Cognitive Behavioural Therapy

Rehabilitation Counselling

Dialectical Behaviour Therapy

Psychodynamic Therapy

Interpersonal Psychotherapy

Client-centred Therapy

Marital/Couples Therapy

Family Therapy

Emotion Focused Therapy

Please select diagnoses for the clients you have seen, then in the next section that appears indicate the NUMBER of clients seen in each category.

Anxiety disorders

Cognitive Disorders

Eating disorders

Mood disorders

Personality disorders

Pervasive Developmental Delay

Psychotic disorders

Sexual Disorders

Substance use disorders

Forensic Clients - Inpatients

Forensic Clients - Outpatients

Educational Background

List Previous Practicum (if applicable)

References

Letters of Reference will be sent from the following (list two)

Prerequisites

Preference will be given to applicants enrolled in CPA or APA accredited programs, although applicants from nonaccredited programs will also be considered.

Application Procedure Checklist

Applications for Ontario Shores Practicum in Psychology must include:

  • Ontario Shores-specific application form (current form)
  • 1-2 page Cover letter stating areas of interest and goals
  • Curriculum Vitae
  • An undergraduate and graduate transcript
  • Two letters of reference sent electronically from an institutional/ organizational email address directly to the student coordinator. If being sent from another address (e.g., gmail) please be in touch to coordinate.

Please direct completed applications (or inquiries) to:

Coordinator, Student Affairs
Ontario Shores Centre for Mental Health Sciences
700 Gordon Street.
Whitby, ON L1N 5S9
Phone: 905-430-4055
Fax: 905-665-2458
Email: @email

Completed applications should be received no later than February 1. We abide by the Ontario-wide Practicum notification procedures.

If successful, candidate will require the following before placement can commence:

  • An original copy of the Criminal Record Check (CPIC) with vulnerable sector screening (no older than six months prior to placement). Failure to present your CPIC could result in a delay in the start date of your practicum placement. Please note: It can take anywhere from 4-12 week to obtain the CPIC from your local police department.
  • Applicant must be up-to-date with their immunizations (Hep B, measles, mumps, rubella, varicella immune status, TB results (2-step and yearly) and TdP status
  • WEA form (Workplace Education Agreement (available from your university/college)
  • Affiliation agreement between university/college and Ontario Shores, and a Certificate of Insurance must be in place prior to placement.

Personal information you provide to Ontario Shores Centre for Mental Health Sciences (Ontario Shores) is collected pursuant to the Public Hospitals Act R.S.0 1990, c. P.40. It will be used for the purpose of determining eligibility for placement at Ontario Shores and administering placement services. At all times it will be treated in accordance with the provisions of the Freedom of Information and Protection of Privacy Act. If you have questions about the collection of your personal information, please refer to the Privacy & Access pages on the Ontario Shores website or contact the Leader, Privacy & Access at 700 Gordon St. Whitby, ON L1N 5S9; 905-430-4055 ext. 6712.