Externship Interest Form

Externship Interest Form
Thank you for your interest in training at South Shore Counseling!

Please complete this interest form. I will review the information enclosed, and get back to you. If you experience any difficulty with this form or uploading the documents required, please email me directly (max@sscpsli.com).

Please note we have filled positions for Summer and Fall 2026. If you're interested in being considered for Spring 2027, please fill out the form below.

Looking forward to being in touch,
Max Benezra, EdM, MA, LMHC-D
Assistant Director
Your Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Training Information
Graduate Program and University
We accept students who can train with us for both Practicum and Internship. Below, please confirm you would be able to train with us for both periods, for a minimum of 600 hours, and at least 8 months.
How many hours total would you train with us?
When would you be looking to start?
Please review our Training Program description (https://www.sscpsli.com/training). Please confirm that you read the information disclosed.
We require Externs to be on-site at one of our three locations for the majority of their hours. Please confirm you could so do below. Please view our locations via this link (https://www.sscpsli.com/our-locations).
Externs are required to attend two virtual meetings on Friday mornings, from 9AM-11AM. You can attend from home or from one of our offices. These run from September-May. Please confirm you would be able to attend these meetings.
Required Documents
Please upload your resume.

Cancelof
Please upload your cover letter.

Cancelof
Please upload a clinical writing sample; this could be from any of your graduate coursework or any relevant clinical experience.

Cancelof
Should be Empty:

Externship Interest Form

Your Information

Training Information

Required Documents