UNC Charlotte Counseling Center

Graduate Assistantship Application

Name ______________________________________________ Date __________________________

Address ____________________________________________________________________________

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Telephone ___________________________________________

1. List clinical/counseling coursework completed or in progress: _______________________________

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2. List previous clinical/counseling experiences and names and phone numbers of supervisors.

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3. Rate your skills in the following areas on a scale of 1 (poor) to 5 (excellent). In areas where you have no experience, indicate N/A.

_____ a. Intake

_____ b. Individual counseling

_____ c. Group Counseling

_____ d. Research

_____ e. Writing

4. What are your professional goals? ____________________________________________________

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5. List interests that coincide with graduate assistantship at the Counseling Center.

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6. Availability during business hours (8-5). Must document 20 hours of availability.

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Please complete this form, print, and return to: Terri Rhodes, Ph D., Training Director, Counseling Center, 158 Atkins Building. Include this completed application, plus a short resume and one letter of reference.