Submit Your Student Onboarding Documents!Submit Your Onboarding Documents and our Changing Minds Administrator contact you to started! Name * First Name Last Name Date of Birth [MM-DD-YYYY] * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Practicum Start and End Dates * Scheduled Shifts * Students must be in clinic a minimum of 5 hours per practicum day. All students must to be able to commit to being in office a minimum of two consecutive days a week including Wednesdays. Monday, Tuesday, Wednesday Tuesday and Wednesday Wednesday and Thursday Wednesday, Thursday, Friday Other, that has been pre-approved by a manager. Practicum Day Start Times and End Times. Please remember student supervision is on Wednesdays - subject to change. * Student Type * Nursing Student Social Work Student Counseling Student Other Contact Information for University Liaison/Coordinator/Counselor/Director * First Name, Last Name, Credentials, Phone Number and Email Address of the person responsible for the practicum student at the University/college. Upload Documents Below Our Changing Minds Credentialing has received your documents and will contact you!For any questions or concerns, email Jamie@ChangingMindsPsych.Com Emergency Contact Form - Complete and upload with the form below.
