Application for SIU Counseling and Psychological Services Training

Application for SIU Counseling and Psychological Services Training

Internship / Practicum / Volunteer
Thank you for your interest in training opportunities at Counseling and Psychological Services at Southern Illinois University! We offer inclusive, supervised, training opportunities for SIU students and provide practical training experiences to better prepare you for your future career. If you are interested in training opportunities, please complete the form below and a representative will contact you.

If you have any questions regarding training opportunities, please contact Jeffery Bass (618-453-1424) or Jariah Henderson (618-453-6616).
Name

First NameLast Name
Student ID/#Dawg Tag:
Email Address:
example@example.com
Phone Number:
Please enter a valid phone number.
Are you a current SIU student?

YesNo
If yes, please select:

UndergraduateGraduateOther
Academic Program:
Academic Program Start Date:
Expected Graduate Degree Date:
Please describe the training experiences you hope to receive at Student Health Services:
Please check all training experiences you are interested in:

Observe mental health clinical servicesProvide mental health clinical servicesOther
Please list any requirements for your training program (i.e. total number of hours, type of tasks, etc.)
Is there any additional information you would like to provide regarding your interest in training opportunities at Student Health Services?
Please upload a resume, cover letter, or any other documents you wish to include:

Cancelof
Should be Empty: