Harmony Home CAC Internship Application
Please note, this is an unpaid internship
Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Languages Spoken:
*
Please describe your interest in interning with Harmony Home CAC:
*
What would you like to gain from your internship experience?:
*
Educational Information
College/University Enrolled In:
Department/Degree
Resume:
*
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Type of Internship Interest:
*
Internship is REQUIRED to complete a degree at a university.
Internship for professional growth/experience and is NOT associated with degree requirements.
Does your internship require your field supervisor to have a specific degree and/or licensure?:
Yes
No
Unsure
If yes, please list degree and/or licensure requirments:
What is your hour requirement per semester?:
*
Length of Internship
*
One Semester
Two Semesters
Other
Please indicate the term in which you are applying for:
*
Fall 2024
Spring 2025
Other
Start Date:
*
-
Month
-
Day
Year
Date
Completion Date:
*
-
Month
-
Day
Year
Date
Licensure Supervisor/Field Supervisor's Name:
First Name
Last Name
Licensure Supervisor/Field Supervisor's Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Licensure Supervisor/Field Supervisor's Email:
example@example.com
Program of Interest
In the next section, please select your internship program of interest. Please note, that if you select multiple programs, you might be offered interviews for each program as they differ in responsibilities and duties.
Child Advocate Intern
Community Education Intern
Child Protection Team Intern
Family Advocate Intern
Development Intern
Availability:
Please note your schedule availability in the table below. Center hours are Monday-Friday 8:00 am to 5:00 pm. Some weekend/after hours events may be required.
Availability:
Monday Mornings
Monday Afternoons
Tuesday Mornings
Tuesday Afternoons
Wednesday Mornings
Type a question
Wednesday Afternoons
Thursday Mornings
Thursday Afternoons
Friday Mornings
Friday Afternoons
References
Please list two (2) professional or personal references that are NOT related to you.
I authorize Harmony Home CAC to contact my personal references listed and understand that Harmony Home CAC will not be held liable for the release of this information.
*
Yes
No
Reference 1 Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Relationship:
Years Known:
Reference 2 Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Relationship:
Years Known:
Emergency Contact
Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship:
Background Check Release
I grant permission to Harmony Home CAC to initiate, via the Department of Family and Protective Services' online self-service system, a Child Abuse/Neglect Central Registry and a Texas Department of Public Service criminal history check as well as any subsequent checks so long as I am active with the agency. I attest that the information I provide will be correct and that providing false information is a violation of the Texas Penal Code Section 37.10 and agree to update Harmony Home CAC with any changes to my personal information. I am a prospective intern and consent to release information regarding criminal or abuse history to Harmony Home CAC. I AKNOWLEDGE THAT I HAVE READ THE ABOVE AND HAVE PROVIDED MY SIGNATURE BELOW.
Signature
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