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HUMS 215 Intent Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
HACC e-mail address
*
Your answer
HACC ID
*
Your answer
Phone Number
*
Your answer
Major
*
5556 Human Services AAS
5550 Human Services AA
5060 Social Services
5090 Social Sciences
5516 Addiction & Recovery Services
What semester do you plan to complete your Practicum?
Summer 2024
Fall 2024
Spring 2025
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What type of Agency/Population would you prefer to work with?
*
Your answer
In what city or county would you be willing to complete practicum?
*
Your answer
Are you currently working in a Human Service Agency?
*
Your answer
If you are working in the field, do you plan to do your practicum at your agency ?
*
Your answer
Agency Name if you are working in the field and plan to do your practicum there.
Your answer
Questions or Comments?
Your answer
A copy of your responses will be emailed to the address you provided.
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