Internship Application

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* 1. Enter your full name.

First Name

Middle Name

Last Name

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* 2. Applicant Contact Information. Please refrain from using a school email as a point of contact.

Residential Address

Residential Address 2 or N/A

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Select your school from the list below.

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* 4. Select your program type.

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* 5. Select your degree level.

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* 6. Please enter expected graduation date

Date / Time

Date

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* 7. When would you like your internship to begin?

Please select a date. Your official start date may change depending on availability. If you're unsure, please select the first day of the month you'd prefer to begin. Please be aware that our on-boarding process takes several weeks.

Date

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* 8. How many hours per week are you available?

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* 9. Desired length of internship

6 months

9 months

12 months

Other (please specify)

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* 10. How many hours does your school require you to accumulate?

Under 150

150-250

250-350

350-500

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* 11. Do you have experience documenting assessments, treatment plans, interventions, and/or clients’ progress according to Medi-Cal standards?

Yes

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* 12. Please upload any relevant documents you'd like to provide (example include a resume, cover letter, letter of recommendation, etc.).
This is not required but can help with finding the right placement.

PDF, DOC, DOCX file types only.

Choose File

Internship Application

Question Title

* 1. Enter your full name.

Question Title

* 2. Applicant Contact Information. Please refrain from using a school email as a point of contact.

Question Title

* 3. Select your school from the list below.

Question Title

* 4. Select your program type.

Question Title

* 5. Select your degree level.

Question Title

* 6. Please enter expected graduation date

Question Title

* 7. When would you like your internship to begin?

Question Title

* 8. How many hours per week are you available?

Question Title

* 9. Desired length of internship

Question Title

* 10. How many hours does your school require you to accumulate?

Question Title

* 11. Do you have experience documenting assessments, treatment plans, interventions, and/or clients’ progress according to Medi-Cal standards?

Question Title

* 12. Please upload any relevant documents you'd like to provide (example include a resume, cover letter, letter of recommendation, etc.).This is not required but can help with finding the right placement.

* 12. Please upload any relevant documents you'd like to provide (example include a resume, cover letter, letter of recommendation, etc.).
This is not required but can help with finding the right placement.