Name:
*
First Name
Last Name
Phone Number:
*
-
Area Code
Phone Number
E-mail Address:
*
How were you referred to us?
*
QCNC staff member
Facebook
Other (please specify)
Trainings or Certifications:
*
What other commitments do you have during the internship time frame?
*
School
Work
Other
Are you able to come to our Indian Trail, NC office once per month?
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Yes
No
What parts of Charlotte are you able to take clients in?
*
Fort Mill/Rock Hill
Matthews/South Charlotte
Concord
Lake Norman/Huntersville
Central Charlotte
What do you hope to receive from this internship?
*
Tell us about yourself!
*
Submit Application
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