Internship Application

Students interested in completing an internship or practicum at Santa Maria Hostel can initiate the process by completing this application.

The information provided through this form will be kept confidential and will help us determine if we have a placement available to meet your learning objectives.

A member of our training coordination team will reach out to you within 7-14 days of receiving this application to discuss next steps.

Santa Maria Internship Requirements: Student Interns must be actively enrolled in an accredited undergraduate or graduate program in a relevant behavior health field including social work, counseling, or chemical dependency studies. Students must complete a pre-internship interview with a member of the clinical leadership team and be selected for an open intern position. Availability of internship positions depends on the availability of the clinical supervisor, task supervisor, program availability, students schedule, and fit with program needs. An active Affiliation Agreement must be on file with the college or university prior to the start of the internship. Interns are expected to dedicate a minimum of 12 hours a week for a minimum of one full semester to the internship site. Interns must remain in good standing with their college or university for the duration of the internship. Prior to starting the internship the student must complete standard background check and drug testing and complete all assigned pre-internship trainings including Volunteer Orientation and Abuse, Neglect, and Exploitation.

Name*

First NameLast Name

Date of Birth

Date

Email*

example@example.com

Phone Number*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current School, University, or College*

Type of Licensure you are training for*

Expected Internship Start Date*

Date

Expected Internship Completion Date*

Date

Select your available days*

Total Number of Hours Needed for this placement*

Additional notes about your schedule and availability:*

Does your school have an existing affiliation agreement with Santa Maria?*

YesNoUnknown

Please provide details about any specific hours or supervision requirements for your school. *

What are your specific areas of interest or experiences you hope to obtain during your internship? Any specific populations or programs you are hoping to work with at Santa Maria?*

What type of supervision does your school require? What are the required credentials for your agency supervisor?*

Please provide the name and contact information for your school's placement coordinator/liaison. *

Have you completed any other internships? If yes, please share details here.*

Are you a former client of Santa Maria?*

YesNo

Are you a current or former employee of Santa Maria?*

CurrentFormerNo

Do you have a Covid Vaccination Card?*

YesNo

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Please upload a copy of your resume here:*

Date*

Date

Signature*

STUDENT INTERNSHIP APPLICATION

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