PrairieFire Practicum Application

Thank you for your interest in becoming a part of our third year PrairieFire Practicum at Mind & Spirit Counseling Center. Please complete this application form and reach out to Andrea Severson with any questions.

"*" indicates required fields

Date

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Cell Phone

Preferred Phone*

Home

Work

Cell

Email*

What year did you complete the two-year PrairieFire Program?*

Discernment Reflection*

Accepted file types: docx, pdf, Max. file size: 128 MB.

Submit a 1-2 page, single spaced discernment reflection paper.

Letter of Recommendation*

Accepted file types: docx, pdf, Max. file size: 128 MB.

Submit a letter of recommendation from your Spiritual Director.

PrairieFire Practicum Application Fee*

Price:

$50 application + processing fee

Pay by Credit Card*

We collect payments securely via Stripe.

PrairieFire Practicum Application

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