Professional Counselor Associate Application
Please complete the form below to apply for an internship with Wild Wish Counseling.
Please select the quarter you would like to begin your internship:
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Spring 2024
Summer 2024
Fall 2024
Winter 2024
Spring 2025
Summer 2025
Fall 2025
Winter 2025
Spring 2026
Summer 2026
Fall 2026
Winter 2026
Full Name
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First Name
Middle Name
Last Name
Suffix
Preferred Pronouns
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Current Address
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Street Address
Street Address Line 2
City
State
Zip Code
Social Security Number
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(XXX-XX-XXXX)
Date of Birth
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-
Month
-
Day
Year
Phone Number
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-
Area Code
Phone Number
Email
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example@example.com
Educational Information
School Affiliation
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Year of Graduation
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ex: 2025
Are you seeking practicum or internship placement?
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Practicum Only
Internship Only
Both
How many direct client contact hours does your program require?
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How many indirect client contact hours does your program require?
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How many individual hours does your program require?
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How many relational hours does your program require?
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How many group hours does your program require?
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Altogether total number of hours required by your program?
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In what languages are you fluent?
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How did you hear about Wild Wish Counseling?
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Have you been convicted of any criminal activity or had any ethics violations?
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Yes
No
If yes, please explain the circumstances. This will not necessarily prevent you from an invitation into our program.
Should you be selected for an internship with Wild Wish Counseling, are you willing to comply with all background check requirements?
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Yes
No
Open Ended Questions
Please include your statement of interest in the Wild Wish Counseling Internship program below:
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What client population(s) are you interested in serving?
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What theoretical approach do you currently use? What do you enjoy most about your current approach?
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Please describe how you would like to expand your theoretical approach during your internship:
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In your graduate program and/or personal therapy, please describe what have you learned about yourself in regards to how you relate to yourself and others?
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Commitment and Availability
Wild Wish Counseling will do the best we can to consider your scheduling preferences when developing the intern schedule. As best as you can at this time, please indicate below the days and times you are available to see clients:
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Are you available to commit to seeing 12-15 clients per week for the duration of your contract?
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Yes
No
Wild Wish Counseling asks for a weekly time commitment of 20 hours, including direct client hours, individual and group supervision, and administrative work. Can you make this commitment?
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Yes
No
Is a personal Interview possible?
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Yes
No
If No, what hours are best for a virtual interview?
Ex: M-W from 2:00-4:00 pm, PST
Resume and References
Reference 1 - Full Name
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First Name
Last Name
Suffix
Reference 1 - Relationship
*
Reference 1 - Phone Number
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-
Area Code
Phone Number
Reference 1 - Email
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example@example.com
Reference 2 - Full Name
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First Name
Last Name
Suffix
Reference 2 - Relationship
*
Reference 2 - Phone Number
*
-
Area Code
Phone Number
Reference 2 - Email
*
example@example.com
Please submit your resume.
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Upload Resume
PDF Only
Cancel
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Signature: I understand and agree that submitting this application does not automatically register me as an intern with Wild Wish. By submitting this form, I attest that the information I have provided is true and is submitted voluntarily.
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Submit
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