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Intern/Practicum Application
Please note: We are no longer accepting intern applications for Fall 2024 if licensed supervision is required.
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* Indicates required question
Email
*
Your email
Name
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Your answer
Full address
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Your answer
Phone number
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Your answer
College/University attending
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Your answer
Internship or Practicum
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Internship
Practicum
Required
Major
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Your answer
Are you a current Glade Run employee?
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Yes
No
Required
Total number of hours requested
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Your answer
Internship start AND end dates
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Your answer
Advisor's name, email and phone number
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Your answer
Please list internship requirements. Be as specific as possible.
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Your answer
Level of internship requested
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Bachelor's level
Master's level
Required
List your highest degree earned at time of application
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Your answer
Level of supervision required
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Bachelor's Level
Master's Level
What is required of your practicum/internship supervisor? List degree(s), license(s) and level of experience as applicable.
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Your answer
List your internship availability (dates, days, hours)
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Your answer
With what age groups/genders do you prefer to work
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Your answer
At which location(s) are you interested in interning
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Butler
Beaver Falls
New Castle
Pittsburgh
Rochester
Utica
Zelienople
Other:
Required
Type signature here
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