Your email

First Name

Last Name

Phone

What type of internship/training experience are you interested in? *
Practicum & Internship combined (Graduate Level)Practicum (Graduate Level)Internship (Graduate Level)Internship (Undergraduate)Other

Where are you attending school and what type of degree program are you currently enrolled in? *

When would you need to (or want to) start your training with us if selected?*

What are the specific requirements that your school requires you to meet for your internship/practicum/training? (number of hours, direct vs indirect hours, any special types of cases you need to work with) *

Do you have to be supervised by someone with specific credentials? If yes, what credentials does that supervisor need to have? *

Which Location would you be willing/able to commute to? (Please note that location assignment is dependent on which supervisor you are matched with) (Check all that apply) *
BoazHuntsvilleJacksonvilleJasper

Submit your cover letter or resume. If you are unable to attach using this form, we can work with you to find another way to get that information from you.