Alameda County Behavioral Healthcare (ACBH) Internship Program Application

Question Title

1. Student Demographic/Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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2. Current College/University Attending

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3. What is your educational program?
(Please specify the name of your program)

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4. What year are you in your educational program?

First Year

Second Year

Third Year

Fourth Year

Fifth Year

Sixth Year

Seventh Year

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5. What is your degree level?

Psy.D, Ph.D or other related Doctorate

Ph.D

MSW

MFT

Other (please specify)

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6. Are you interested in a clinical or non-clinical (administrative) internship?

Clinical

Non-Clinical (Administrative)

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7. Please provide the name and contact information of your school's internship program coordinator:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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8. What is your enrollment status at the time of this application?

Full time

Part time

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9. How many hours per week are you available to work on an internship assignment?

Other (please specify)

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10. What system of care are you most interested in working with?

Children & Young Adult

Transitional Age Youth

Adult

Older Adult

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11. Please enter your preferred internship assignment start date:

Date / Time

Date

Alameda County Behavioral Healthcare (ACBH) Internship Program Application

Question Title

* 1. Student Demographic/Contact Information

Question Title

* 2. Current College/University Attending

Question Title

* 3. What is your educational program?(Please specify the name of your program)

Question Title

* 4. What year are you in your educational program?

Question Title

* 5. What is your degree level?

Question Title

* 6. Are you interested in a clinical or non-clinical (administrative) internship?

Question Title

* 7. Please provide the name and contact information of your school's internship program coordinator:

Question Title

* 8. What is your enrollment status at the time of this application?

Question Title

* 9. How many hours per week are you available to work on an internship assignment?

Question Title

* 10. What system of care are you most interested in working with?

Question Title

* 11. Please enter your preferred internship assignment start date:

Question Title

* 12. Upload Supporting Documents (Optional)Please upload any relevant documents such as a resume, cover letter, or letters of recommendation.

1. Student Demographic/Contact Information

2. Current College/University Attending

3. What is your educational program?
(Please specify the name of your program)

4. What year are you in your educational program?

5. What is your degree level?

6. Are you interested in a clinical or non-clinical (administrative) internship?

7. Please provide the name and contact information of your school's internship program coordinator:

8. What is your enrollment status at the time of this application?

9. How many hours per week are you available to work on an internship assignment?

10. What system of care are you most interested in working with?

11. Please enter your preferred internship assignment start date:

12. Upload Supporting Documents (Optional)
Please upload any relevant documents such as a resume, cover letter, or letters of recommendation.