Clone of Peachtree Autism Services Employment Application Form

Internship Application

This application is intended for an internship position at Peachtree Autism Services. This is a non-employee, unpaid volunteer internship designed to provide experience and training in the field of Applied Behavior Analysis (ABA) within a clinic serving children with autism.

Interns support the classroom team with day-to-day tasks as part of the Registered Behavior Technician (RBT) experience and may gain valuable training and hands-on experience implementing ABA programming. This internship is ideal for candidates pursuing a career in special education, applied behavior analysis, speech-language pathology, occupational therapy, social work, education, or a related field.

If you have any questions or need additional information, please contact Kim Duong at kduong@peachtreeautism.com
or 470-223-8123

Each question on this application must be answered completely and accurately. No action will be taken on this application until all questions have been answered and the application has been signed and dated.

Full Name*

First NameMiddle NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Confirmation Email

What is your current educational status?*

Enrolled in undergraduate programGraduated with my Bachelor'sEnrolled in graduate programOther

Is this internship connected to course credit or a practicum requirement by your academic program?*

YesNoNot sure

If yes, what are the specific requirements set by your school (hours, supervision, evaluations, documentation)?*

What are the required start and end dates for your internship?*

Will your school require a learning contract, evaluation forms, or supervisor verification?*

Who is the academic supervisor or faculty contact for your internship?*

Are you fluent in a foreign language?*

YESNO

Are you over the age of 18?*

YESNO

If yes, what language(s)?*

Have you been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, provide the location, date and result/outcome for each conviction:*

EDUCATION

Please complete the appropriate sections*

Rows	Name & Location of School	Did You Graduate?	Degree or Certification	GPA
GED / High School
College
Graduate

ADDITIONAL INFORMATION

What do you hope to experience or learn during this internship?*

What does professionalism mean to you in a workplace setting?*

Type signature*

Date*

MonthDayYear

To upload your resume, click Choose File*

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To upload a cover letter, click Choose File

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