Application for Internship/Practicum
Student /Applicant Information
Students Name
First Name
Last Name
Phone
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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University/Grad Program Information
Name of University
Grad Program you are attending
Pursued degree
Excepted date of completion
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Month
-
Day
Year
Date
Proposed start date of intership/practicum
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Month
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Day
Year
Date
Proposed end date of internship/practicum
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Month
-
Day
Year
Date
This site requires the use of a personal vehicle (mileage reimbursed) to drive to see participants in homes, schools, and other site in the community. Can you commit to this?
Yes
No
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Please answer the following questions:
Please describe why you are interested in pursuing the Children's Home Counseling Services for your internship/practicum.
Please describe your goals for your internship/practicum.
Please describe any previous or current experience(s) working/volunteering with children, adolescents and families and any other relevant experience you may have.
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The internship requires interns to meet with participants, maintain accurate and timely documentation, communicate with supervisor and program manager, and to meet deadlines. Is this something you believe you can commit to? What areas might you needs help to meet these requirements?
Is there anything that you believe is important for us to know in our consideration of your application?
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Please include a cover letter and resume with this application.
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