Intern Application

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Intern Application

DNM Health Services is an Equal Opportunity Employer.

Email *

Intern Name *

First and last name

Phone Number *

Address *

University Attending *

Expected Degree *

YYYY

Expected Graduation Date *

YYYY

Internship Start and End Dates *

YYYY

Does your school require a minimum number of "direct" hours? If so, how many hours or what percentage? *

Why do you want to intern with a private practice? *

How did you hear about Pathways FCS? *

What ages, populations, diagnoses, and concerns are you especially interested in working with? *

Please check the boxes that apply to you: *

I am able to commit to the number of internship hours required by my program.

I am able to commute to Stafford, Virginia

I am available to work mornings

I am available to work evenings

I am available to work Saturdays

I am available to attend one hour of supervision per week (times to be discussed)

I understand that most of my internship hours will occur with clients, without a supervisor present.

Required

Send me a copy of my responses.

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