PLADC Practicum Federal Funding
First Name:
Last Name:
E-mail:
Telephone:

Do you speak Spanish?    Yes 
 No

Are you a US citizen?    Yes 
 No

Will you be employed by UNO, UNL, or UNK during your practicum?    Yes 
 No

Will you be enrolled in a college or university during the entire length of your entire practicum?    Yes 
 No

Have you completed the 270 hours of initial education required for licensure as a drug and alcohol counselor?    Yes 
 No

 
Please email Laura Holly at laura.holly@unmc.edu a copy of your resume along with this application.