Use this form to request consideration for an internship at the Central Office of DBHDS. The Central Office functions as the statewide policy, planning, and administrative entity for the behavioral health and developmental services system, therefore, we do not provide clinical internships. You would need to contact the individual facilities to inquire about clinical opportunities.

Please be as specific as possible regarding your answers. Failure to do so may result in not being contacted for any openings we may have available to you.

Contact cecily.rodriguez@dbhds.virginia.gov with questions.

First Name

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* 1. First Name

Middle Initial

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* 2. Middle Initial

Last Name

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* 3. Last Name

Email

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* 4. Email

Alternate email

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* 5. Alternate email

Phone number

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* 6. Phone number

Alternate phone number

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* 7. Alternate phone number

What school do you attend?

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* 8. What school do you attend?

Where is this school located?

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* 9. Where is this school located?

What degree are you seeking? (specify undergraduate or graduate)

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* 10. What degree are you seeking? (specify undergraduate or graduate)

Do you have an area of concentration in your degree program? If so, please describe.

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* 11. Do you have an area of concentration in your degree program? If so, please describe.

What date range are you requesting for your internship?

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* 12. What date range are you requesting for your internship?

What hours/days are your requesting for your internship?

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* 13. What hours/days are your requesting for your internship?

In what area of DBHDS are you wanting to intern?

Please review the DBHDS website at http://www.dbhds.virginia.gov/ before you answer.
Please list your top three choices.
Please be specific.

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* 14. In what area of DBHDS are you wanting to intern?

Please review the DBHDS website at http://www.dbhds.virginia.gov/ before you answer.
Please list your top three choices.
Please be specific.

Is this a formal internship under the direction of your university program?

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* 15. Is this a formal internship under the direction of your university program?

If yes, please describe the requirements that are needed to fulfill this internship.

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* 16. If yes, please describe the requirements that are needed to fulfill this internship.

If no, why are you seeking an internship with DBHDS Central Office?

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* 17. If no, why are you seeking an internship with DBHDS Central Office?

What qualities would make you a desirable and successful intern at DBHDS?

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* 18. What qualities would make you a desirable and successful intern at DBHDS?

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