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Internship Application Form
Thank you for your interest in an internship at HBH Wellness. Please complete the form below. The details of this application is important in determining the best fit for your internship experience.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Physical Address
Your answer
Email
*
Your answer
Phone number
*
Your answer
Current Education Level
*
Choose
Associates
Bachelor's
Master's
Projected Graduation Date
MM
/
DD
/
YYYY
Current Major/Area of Study
Your answer
What year are you in?
Your answer
Internship Semester
Spring
Fall
Summer
Clear selection
Service Population Interest
*
Substance Abuse Disorder
Mental Health
Focus Interest
*
Clinical: Individual Counseling, Group Counseling, Assessment, Case Management
Administrative: Grant Writing, Program Planning, Advocacy, Data & Evaluation
Time Commitment
*
Choose
0-5 Hours per week
5- 10 Hours per week
10-15 Hours per week
20+ Hours per week
Submit your cv or resume
Your answer
Does this internship require the supervision of a Licensed Professional?
*
Yes
No
Not Sure
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