Cornerstone Counseling & Wellness, PLLC Practicum/Internship Application

1
Do you have your Application Documents ready to submit?Cover Letter, Resume, Curriculum Vitae/Unofficial Transcript, and Two (2) Letters of Recommendation
YESNO
2
Name* This field is required.
First Name
Last Name
3
Phone Number* This field is required.
Area Code
Phone Number
4
Email* This field is required.
example@example.com
5
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
You are applying for:* This field is required.
Practicum
Internship
Multiple Practicums
Both Practicum(s) and Internship
7
How many direct counseling hours are you needing?* This field is required.Direct counseling hours is the time you spend face to face with a client providing counseling.
8
How many indirect hours are you needing?* This field is required.Indirect counseling hours is the time you spend preparing for counseling sessions. This includes a variety of tasks.
9
Name of Current University* This field is required.
10
What degree are you currently pursuing?* This field is required.
11
Licensure Track:* This field is required.
Please Select
Please Select
LCHMC
LMFT
LCSW
Other
12
What is your current overall GPA?* This field is required.
13
Date of Expected Graduation* This field is required.
Date
Year
Month
Day
14
Practicum/Internship Start Date* This field is required.When do you plan to be available to begin your internship/practicum?
Date
Month
Day
Year
15
What populations are you most interested in working with in counseling?* This field is required.
16
Who is your LMFT-S/LCMHC-S?Type "N/A" if non-applicable
17
LMFT-S/LCMHC-S Phone Number
Area Code
Phone Number
18
LMFT-S/LCMHC-S Email
example@example.com
19
Cover Letter* This field is required.Please provide your responses to the following questions within the cover letter: What led you to a career in licensed mental health counseling? Why are you seeking a practicum/internship in an integrative counseling setting? What is your counseling theory?
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
20
Resume* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
21
Curriculum Vitae -OR- Unofficial Transcript* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
22
Recommendation Letter* This field is required.Recommendation letters are to be from faculty and/or supervisors or previous/current employers.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
23
Recommendation Letter* This field is required.Recommendation letters are to be from faculty and/or supervisors or previous/current employers.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
24
While onsite, you will be meeting with a Site Supervisor regularly (according to the requirements of your program). Please note: There is only one LCMHC-QS who is a Site Manager. If that Site Manager is not available, then you will need to find a separate LMFT-S or LCMHC-S for your hours to count toward licensure (this is typically your Practicum/Internship Professor). Otherwise, your hours onsite with the site supervisor will only count toward the completion of your degree. By typing your name below, you acknowledge your responsibility in finding a LMFT-S or LCMHC-S.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: