Clinical Internship Application Form

Name*

First NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

example@example.com

In what languages are you fluent?

School Affiliation/Yr of Graduation

Please indicate the quarter and year in which you would like to begin your internship:

Example: Fall 2026

How long is your internship?

Example: 9 months

How many internship hours does your program require?*

Please answer the following questions:

1. Please tell us why you're interested in working with Dream Life Out Loud, PLLC. What benefits do you expect this experience will add to your growth as a therapist?

2. Our goal is to empower individuals, couples, and families to understand themselves more deeply through healing and growth for the mind, body, and spirit. Please describe your professional and or personal development that has allowed you to do this work.

3. Please describe your level of interest in private practice and what are your post-graduate goals.

4. We aim to decolonize therapeutic healing spaces with a justice-oriented approach. We aim to help people heal from the global institution of racism, racial injustice, discrimination and prejudice. How have you been personally impacted by systemic oppression and/or privilege? How might these experiences impact your clinical practice?

5. Please describe your current limitations, vulnerabilities, and/or biases that may impact your clinical work and/or ability to sit with specific client populations. How will you address these limitations when they arise?

6. Is there anything else you would like us to know about you, your experience, training, and background?

Scheduling availability is a key factor in the extension of an invitation into our Clinical Internship Program. As best as you can at this time, please indicate below the days and times you are available to see clients at the time of your internship.

Commitment and Availability

Rows	Monday	Tuesday	Wednesday	Thursday	Friday
Morning 9-noon
Afternoon noon-5pm
Evening 5pm-8pm

Please share your interest and days that you are able to provide in person services.

Are you available to commit to seeing 10-12 clients per week for the duration of your contract? Please Explain.

Are you able to commitment between 20-25 hours, including direct client hours, individual and group supervision, and administrative work. Please Explain.

Resume

Letter of Interest/Cover Letter

Letter of Recommendation: Please submit one to two letters of recommendation one from a faculty member and one from a supervisor who can speak to your clinical skills and commitment to this work.

Date

Thank you for submitting your completed application including a letter of interest and resume. Each applicant will be contacted via email if more information is required and to inform the student of next steps. We prefer email communication throughout the application process. If for any reason it's 's not preferable for us to contact you via email, we will gladly contact you via the mode of communication you provide on the application. If you have any additional questions please contact us at info@dreamlifeoutloud.com

Additionally I understand and agree that submitting this application does not automatically register me as an intern with DLOL. By submitting this form, I attest that the information I have provided above is true and is submitted voluntarily.

Thank you! We look forward to getting to know you!