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Internship Application
We would love to see if we are a good match for your clinical internship!
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Email
*
Your email
Name:
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Your answer
Preferred Pronouns:
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she/her
he/him
they/their
Other:
Required
Best phone number to reach you at:
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Your answer
What program are you currently enrolled in?
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Your answer
What are your contact clinical hour requirements? How many are designated for a specific type (relational, group, etc.)?
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Your answer
What is your anticipated internship/practicum dates?
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Your answer
What level of licensure does your program require for supervision of your internship/practicum (i.e. LCSW, LMFT, etc.)?
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Your answer
We require a commitment of Practicum and Internship with no interruptions. Are you willing and able to commit to that?
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Yes
No
Days you would be available for your clinical hours:
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Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Required
Are you available on weekends for community events?
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Yes
No
Maybe
Please list an applicable coursework or experiences you have working with children and adolescents.
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Your answer
What do you hope to get out of this internship/practicum experience?
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Your answer
We see a variety of clients at our practice and it is expected that you will see children, teens and adults based on referrals and need. Please describe any populations/situations that are non-negotiable "no's" for you.
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Your answer
Is there anything else you would like us to know about you?
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Your answer
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