Internship Application
Thank you for your interest in completing your practicum and internship with A New Hope Therapy Center.
Please complete this form and we will be in touch!
Email address *
Name *
Your answer
What program are you currently enrolled in? *
Your answer
What are your contact clinical hour requirements? How many are designated for a specific type (relational, group, etc)?
Your answer
Best phone number to reach you at? *
Your answer
What is your anticipated internship/practicum dates? *
Your answer
We require a commitment of Practicum and Internship with no interruptions. Are you willing/able to commit to that? *
Days you would be available for your clinical hours: *
Required
Please list any applicable coursework or experiences you have working with children and adolescents. *
Your answer
What do you hope to get out of this internship experience? *
Your answer
We see a variety of clients at our practice. Please describe any populations/situations that are non-negotiable "no's" for you. *
Your answer
Is there anything else you would like us to know about you? *
Your answer
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