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Internship Information Form
Thank you for your interest in interning with North Star Therapy Collective
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Name
*
Your answer
Preferred Pronouns
*
Your answer
Email
*
Your answer
School Name
*
Your answer
Program Name and/or Specialty
*
Your answer
Interested in:
*
Practicum (1st Year Pleacement)
Internship (2nd Year Placement)
Both
Other:
Hours Needed for Internship
*
Your answer
Preferred Start Date
*
MM
/
DD
/
YYYY
Internship Completion Date
*
MM
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DD
/
YYYY
Supervision Type
*please note if there are specific requirements for your program*
*
In Person
Virtual
Hybrid
Other:
Please list the supervision requirements for your program
Your answer
Please share what interests you in interning at North Star Therapy Collective specifically.
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Would you like to be added to our list for future employment opportunities?
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