• 2A Lalupon Close, Off Keffi Street, Ikoyi Lagos
  • info@thecicn.org
  • +234817 944 0956
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PRACTICUM REGISTRATION FORM

Please complete this form accurately. All information provided will be treated confidentially. Submission of this application does not guarantee placement until approval has been granted by the Chartered Institute of Counseling in Nigeria (CICN).

Section A: Personal Information

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Gender
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Section B: Academic Information

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Section C: Practicum Details

 This practicum required by your institution?
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Section D: Preferred Placement Area

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Section E: Academic Supervisor Information (If Applicable)

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Section F: Previous Experience

Have you previously completed any practicum?
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Section G: Skills & Interests

Please indicate areas where you have knowledge or experience.
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Section H: Supporting Documents

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Section I: Medical & Accessibility Information

Do you have any medical condition or accessibility need that may require accommodation during your practicum?

Section J: Declaration

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  • 2A Lalupon Close, Off Keffi Street, Off Awolowo Road, Ikoyi Lagos
  • info@thecicn.org

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