Veterans_Administration_APPLICATION_FOR_PRACTICUM - Site...

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APPLICATION FOR PRACTICUM  VA Palo Alto Health Care System Recreation Therapy Service NAME:  ______________________________________________________________________________ ADDRESS:  ___________________________________________________________________________   PHONE NUMBERS:  Home: ________________________  Work: __________________________ Cell:  _________________________  Other:  __________________________ EMAIL Address: _______________________________________________________________________ UNIVERSITY:______________________________                  YEAR IN PROGRAM: _________  Please  rank order your preferences (if any) for: Long Term Care: ____ Polytrauma____ Fitness/Wellness_____ Mental Health_____  Rehabilitation_____ No Preference_____   PREVIOUS PRACTICUM OR RECREATION EXPERIENCE Site: ________________________________________________ Hours: _____________________ Population: _____________________________________
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Unformatted text preview: Site: ________________________________________________ Hours: _____________________ Population: _____________________________________ RECREATION THERAPY COURSES TAKEN TO DATE ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ DAYS AND HOURS AVAILABLE FOR PRACTICUM: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please mail your completed form to : Andy Duprey, Practicum Student Coordinator-Recreation Therapy Service 11K Palo Alto-3801 Miranda Ave, Palo Alto, CA 94304 Or E-mail to [email protected] Please call (650) 493-5000 x63289 or (650) 444-8714 if you have questions. …………………….thank you...
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  • '10
  • Ross,Susan
  • ........., Week-day names, Palo Alto Health Care System Recreation Therapy Service, Preference_____ PREVIOUS PRACTICUM

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Veterans_Administration_APPLICATION_FOR_PRACTICUM - Site...

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