Practicum Enrollment Form

The Coaching Practicum is an intense, individualized opportunity for students to look at their coaching with the goal of honing their skills as they prepare for submitting oral exams. All students will participate in multiple, complete coaching sessions. Detailed, written feedback and session discussions, tied to the ICF-PPC Markers, will be given each time a student coaches.

All participants must have a reliable internet connection, free from distractions, for the full session.

Session Format:

Session 1

60 minutes
Introduction, seeing expectations, review of competencies, goal setting

Sessions 2,3,4

180 minutes each
Three 40 minute coaching sessions
20 minute feedback/debrief correlated to the ICF Competencies and PCC Markers

Practicum fee: $1250

Payment due by February 1, 2025 in order to allow for time to run the practicum without postponing graduation.

Full Name *

Phone *

Email *

Who referred you?

I agree to pay right away through the following means:

Zelle - to [email protected]

ACH (write your routing number and your account number in the space provided below and we will withdraw the amount once or monthly)

Check made out and mailed to Family Recovery Resources, LLC, ℅ Beverly Buncher, 6698 Tenth Ave N Apt 318, Lake Worth, FL, 33467

If you are using ACH, please provide your routing number

And your account number

Signature

Clear

Date Signed

Please sign and submit this agreement which will indicate the:

Item or service you paid for
Amount paid/agreed to
Form of payment
Payment information
Your signature

Please complete payment upon completion of this form. As soon as we get your confirmation, we will enroll you.

If you have any questions or concerns, please feel free to contact Bev at [email protected] or call me at 786-859-4050.

I CERTIFY THAT I HAVE READ, SIGNED, AND EMAILED THE PROGRAM AGREEMENT TO THIS PAYMENT FORM AND UNDERSTAND THAT THE INFORMATION ON THE AGREEMENT AND THIS FORM ARE BINDING.

I CERTIFY THAT THE ABOVE STATEMENTS AND INFORMATION MADE IN THE AGREEMENT AND ON THIS FORM ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT I WILL PAY THE AMOUNT(S) AGREED TO AS AGREED.