Practicum/Internship Application
Enter your details to be considered for an internship with Imani Behavioral Health
Full Name
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First Name
Last Name
Date of Birth
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Ex: mm/dd/yyyy
Gender
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Please Select
Male
Female
Other
Phone Number
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Please enter a valid phone number.
Email Address
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example@example.com
University
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Major
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GPA
*
Expected Graduation Date
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Ex: mm/dd/yyyy
Practicum or Internship?
How many hours total do you need?
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Include totals for direct, Indirect, group, and supervision hours
Which semester do you prefer?
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Please Select
Fall
Spring
Summer
Exact Dates of the Semester
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Ex: mm/dd/yyyy - mm/dd/yyyy
University Practicum/Internship Supervisor/Coordinator Contact Information
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First and Last Name
Email or Phone Number
Will you need any accommodations?
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Please Select
Yes
No
If you need accommodations, what kind?
*
What is your work availability, if selected?
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Include days of the week and times
What is your interview availability?
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Include days of the week and times
Which location do you prefer?
*
Please Select
93 Beaumont St, Clarksville, TN 37040
406 Royal Parkway, Nashville, TN 37214
Internship Type
*
Please Select
Counseling
Doctoral Counseling
Marriage and Family
Psychiatric Nurse Practitioners
Social Work
Accounting
Billing/Coding
Business
Communications
Graphic Design
Healthcare Administration
Marketing
Photography or Film
Social Media
Upload Resume
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May include student organizations, job experiences, additional coursework, skills, degrees, or licensures
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How did you hear about us?
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Please verify that you are human.
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