Expression of Interest: To Host Placement Students Expression of Interest: To Host Placement Students Thank you for taking the time to complete this form. Cairnmillar are seeking expressions of interest from organisations who may have opportunities to host placement students in 2023. Please complete the following form and we will be in contact with you to discuss your expression of interest. If you require further information, please contact our placement team by email placements@cairnmillar.org.au. Current Partnership Status: * We are currently hosting a Cairnmillar placement student We have hosted a Cairnmillar placement student in the past We have not hosted a placement student in the past but have been liaising with CMI staff Are you interested in hosting a placement student in 2023? * Yes No, but maybe following year No, please remove our details from your database Organisation Contact Details: When selecting courses from the list below, please be aware that only our Master for Clinical Psychology (Post -Registration) course is online and State-wide. All of our other courses are campus-based in Victoria. Organisation Name: * Main Contact Person: * Main Contact Person’s Email: * Main Contact Person’s Number: * Suburb/s where placements may be available) * State * VIC NSW WA QLD ACT NT SA TAS Website URL: * Please indicate which placement students you are interested in hosting for 2023 (select all that apply): * Master of Professional Psychology Students (MPP; 5th year): 2-3 days/weeks for approximately 4 months. Master of Professional Psychology Practice (Interns; 6th year): 2-3 day/week s per week for approximately 12 months. Master of Clinical Psychology: 2 days/per week for between 4-5 months. Doctor of Clinical Psychology: 2 days/week for 4-5 months. Master of Clinical Psychology (Post-Registration): 2-3 days/per week for between 4-5 months. Graduate Diploma of Counselling: 1-2 days/ per week for between 4-5 months. Master of Counselling: 1-2 days/ per week for between 4-5 months. NOTE: Only our Master for Clinical Psychology (Post -Registration) course is online and State-wide. All other courses on this list are campus-based in VIC. How many students can your organisation potentially host in 2023? * Please enter the name of the contact person or people at the Cairnmillar Institute the organisation liaise(d) with regarding student placements. * What client populations does the organisation predominantly provide services to? (check all that apply) Children under 12 years old Children/adolescents aged 12-17 years old Adults aged 18 years and over Older Adults aged 55 years and older Couples Families OtherOther Please provide a brief description of the services provided by the organisation: This will assist us to find students with interests that align with your organisation. Do you have any further information you wish to provide? Removal of organisation from Cairnmillar Institute Partnership Program Please fill in the below details. Agency / School Name: * Primary Contact Person: * Primary Contact Number: * Email Address: * Thank you for providing placement opportunities to our students over the years. We wish you well. Thank you for taking the time to complete this form. A Cairnmillar staff member will be in contact to discuss placement opportunities with you. The Cairnmillar Placement Team If you are human, leave this field blank. Submit Δ
