CCC Internship Learning Clinic Application
CCC is proud to offer a robust internship/practicum program featuring micro (direct service), mezzo, and macro level experiences coupled with ample training and supervision. Each year we host 8-12 interns dedicated to serving a diverse array of mental health needs.
Legal Name
First Name
Last Name
Name (if different from above)
Pronouns (optional)
Phone Number
Email
*
example@example.com
Please indicate which category best describes the type of internship you are looking form.
Counseling practicum and internship (this is recommended to allow you more time to meet direct service hours)
Counseling internship only
Doctorate of Psychology externship
MFT or Couples Counseling
MSW 1st year (macro/mezzo placement)
MSW 2nd year/advanced placement (micro focused)
MSW 2nd year (macro/mezzo focused)
Bachelor's level internship
Other
Please fill out the BA Internship application found here:
https://hipaa.jotform.com/252118255577158
Are you able to be physically in the office at least one day a week during your internship?
Yes
No
Anticipated Start and End date.
If you are not sure of the exact dates, put the 1st day of the month your practicum/internship will begin or end.
Anticipated Start Date:
*
-
Month
-
Day
Year
Anticipated End Date
*
-
Month
-
Day
Year
University you are attending. IF your university is not listed, you will be required to update your program's supervision/site requirements to be considered as part of the application process.
*
Bushnell University
Pacific University
Oregon State University
Universtiy of Oregon
Western Seminary
Other
Cover Letter
*
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Please submit a letter of interest or cover letter in a Word or PDF format
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Resume/CV
*
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Please submit a resume/CV in a Word or PDF format
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IF your school is not listed, please provide a copy of your school's requirements regarding site responsibilities and supervision/supervisor requirements.
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Have you started attending classes for your program yet?
Yes
No
References
Please provide the name and email address of two references. If you have started your program, you are asked to provide one professional reference and one academic reference. If you have not yet started your program, you are asked to provide two professional references.
Name of Professional Reference
First Name
Last Name
Email of reference
example@example.com
Name of Professional Reference 2 (for those who have not started classes)
First Name
Last Name
Email of Professional Reference
example@example.com
Name of Academic Reference
First Name
Last Name
Email of academic reference
example@example.com
Submit
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