Internship Application
Please complete this form to apply for the internship program at Grace Abounds Counseling & Psychological Consulting, LLC.
General Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Present Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your present address also your permanent address?
*
Yes
No
Permanent Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current University/College
*
Major/Program of Study
*
Level of education that will be completed at the end of the Internship
*
College 1st Year/Freshman
College 2nd Year/Sophomore
College 3rd Year/Junior
College 4th Year/Senior
Master's Level/1st Year
Master's Level/2nd Year
Doctoral Internship
Psychiatric NP Master's Program
Other
Is an internship/practicum required for your program of study?
*
Yes
No
Emergency Contact
Please provide information for your emergency contact person.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Interests and Skills
What type of work would you be most interested in doing during your internship?
*
Please list computer skills below. Include your level of knowledge of specific programs.
*
List below your abilities to communicate in any languages other than English and indicate your proficiencies on a scale of weak, good, or fluent.
Expectations and Motivations
What talents and abilities would you bring to the GACPC internship program?
*
What draws you to the GACPC internship program? What do you hope to gain from an internship with GACPC?
*
Please indicate the months/semesters in which your internship will occur. Please also indicate the start date for your internship semester.
*
How did you hear about this internship?
*
Additional Document
Please provide a copy of your resume or CV.
*
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