Application for PSY 391-392 Internship in Psychology

Name

First NameLast Name

Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Phone #

Area CodePhone Number

Cell Phone #

Area CodePhone Number

Email

example@example.com

Summer Phone #

Area CodePhone Number

Summer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List by number and name all of the courses you have taken in Psychology (including Spring courses currently underway)

Rows	Course #	Course Name	Course #	Course Name
1
2
3
4
5

Are there any other courses have you taken which might be helpful to your work at an internship placement? If so, note them below.

When (month/year) do you expect to graduate from Le Moyne College

What is your overall GPA?

What is your GPA in Psychology?

Please see your transcript in Phinfo

YesNo

What are your plans after graduation

What do you hope to gain from an internship experience? Are there specific types of individuals you wish to work with,e.g., children, delinquents, homeless, or, are there specific kinds of placements you might seek, for example, mental institution, school setting.

Are there any specific types of individuals or settings you would definitely NOT be willing to work with/at?

What strengths do you bring to a possible internship placement?

Is there anything further you wish to comment upon or mention?

Yes

I understand that participation in the Internship Program requires:

8 hours per week at your placement site (in addition to any travel time). This is usually done in blocks of 3-4 hours, 2-3 times per week. *please remember to save this time in your class schedule
1 hour of classroom attendance and engagement (in addition to the above) on Thursdays at 4:30 pm.
A full-year commitment to your placement site (both Fall and Spring semesters).

Yes

By clicking "Submit", please note that you are indicating that all information in this application is accurate (to the best of your knowledge) and that you are agreeing to commit to the program and class for a full academic year. If you have any questions or concerns about this, please reach out to your advisor or the chair of the Psychology Department (Dr. Sylvia: sylviamr@lemoyne.edu) before submitting your application.