PSIMED Corrections Practicum
This survey is to gather information on your interest and field work needs for practicums or internships at PSIMED Correction locations. You will be contacted to set up an informational interview, additional interviews at specific locations will be scheduled after the informational discussion.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
School/University
Degree Program (e.g., MSW, MA Counseling, MS Psychology
Focus/ Concentration (if applicable)
Program Requirements
1. I'm interested in speaking with PSIMED about (check all that apply)
Practicum
Internship
Generalist Practicum
Advanced Practicum
Undergraduate Practicum
Experience other than practicum
2. Approximate number of hours required by your program
< 100 hours
100-300 hours
301-600 hours
600+ hours
3. Expected start date for practicum/internship
4. Expected Completion Date
5. How many hours per week?
5-10
11-20
21-30
3+
6. Which semester(s) are you seeking placement?
Summer
Fall
Spring
Year Round
Experience & Interests
7. Please upload your resume here
Browse Files
Drag and drop files here
Choose a file
Cancel
of
8. What areas of mental health practice are you most interested in gaining experience with at PSIMED?
9. What population/age group are you interested in working with at PSIMED
Youth
Adult
Either
Both
10. Desired location(s) for field work (e.g., specific city, region of WV)
11. Are you willing and able to drive 30 minutes or more for a practicum?
Yes
No
12. Do you have specific supervision requirements (e.g., licensed clinical social worker, licensed professional counselor)?
Yes
NO
If you said yes to the above question 12, please specify.
Submit
Should be Empty: