Internship Inquiry Form
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Graduate School:
*
Degree you are pursuing:
*
Please Select
MA Clinical Mental Health Counseling
MA Social Work
Other
If selected other, please list degree below
*
Projected graduation date:
*
-
Month
-
Day
Year
Date
Safe Harbor Internship Application Process
Applications are accepted and reviewed upon submission. Depending on the semester you are applying to start, please note the following schedule. We are accepting Fall 2024 applications through May of 2024. Decisions for the Fall semester are made in July of 2024. Spring 2025 applications may be submitted not later than October of 2024. Decisions for the Spring semester are made in November of 2024.
Please select the type if internship you are applying for:
*
Please Select
Practicum
Internship 1
Internship 2
Foundation Year Field placement
Advanced field placement
Semester you are applying to start
Please Select
Fall 2024
Spring 2025
Summer 2025
Projected start date:
*
-
Month
-
Day
Year
Date
Please include your University deadline below
We cannot guarantee adherence to this deadline, but will take it into consideration during our review process.
Does your university internship include a group hour requirement?
Yes, it is mandatory
Yes, but not mandatory
No group hours needed
Available for in-person scheduling?
Yes, I am local to Maryland and can commute
Yes, but seeking a hybrid schedule
I am not local to Maryland but can commute
No, seeking a fully remote internship
Please select the following Maryland counties you would be willing to work from
Prince George County
Harford County
Baltimore County
Other
Have you ever been released from an internship placement?
*
Please Select
No, I have never been released from an internship placement
Yes, I have been released from a prior internship placement
If so, please describe the circumstances below
Have you previously received services from a Safe Harbor counselor? (Please note: If you have been a past or are a current client, this will not effect our decision to move forward with placement. Special provisions would be made to protect your client information)
Yes, I have received services from a Safe Harbor provider.
No, I have never been a client of Safe Harbor.
Yes, I am a current client of Safe Harbor.
Prefer not to disclose
Other
Upload University Degree Requirements for Internship:
*
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Upload Cover Letter, Resume, and Curriculum Vitae here:
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Thank you for your application.
We will review your application and reach out with further details. Any additional information can be sent to InternshipProgram@safeharborbc.com.
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