May 24, 2022 debby Internship Application Form Internship Application Form Email First Name Last Name Physical Address PhoneCurrent Education Level Associates Bachelor's Master's Projected Graduation Date MM slash DD slash YYYY Current Major/Area of Study What year are you in? Internship Semester Spring Fall Summer Service Population Interest Substance Abuse Disorder Mental Health Focus Interest Clinical: Individual Counseling, Group Counseling, Assessment, Case Managemen Administrative: Grant Writing, Program Planning, Advocacy, Data & Evaluation Time Commitment Does this internship require the supervision of a Licensed Professional? * Yes No Not Sure
