Internship Interest Questionnaire
We are so excited to get to know you and to learn about your internship! Please complete this questionnaire so we can better know how we can assist you.
First & Last Name
Residential Address (please include city & state)
How did you learn about our organization?
University Representative Referral
I am a current employee of Lifeline Youth and Family Services, Crosswinds or Lasting Change Inc.
What is your current education status?
Current Undergraduate Student
Current Graduate Student
Future Undergraduate Student
Future Graduate Student
Which college/university are currently attending or planning to attend?
Is this school online or in person?
What is your degree program?
How many credits is your program?
If you are a MSW degree candidate, please check which track applies:
When is your expected graduation date?
How many internships are needed for your program?
Are you seeking placement for your general practicum or final clinical internship?
Final clinical internship
When is the anticipated start date(s) for your internship/practicum(s)?
How many internship hours are required to complete your internship/practicum(s)?
How long are you internship/practicum(s)? (i.e. 6 months)
Are there any special requirements for your internship(s)?
A specific number of hours required for certain populations (i.e. children, groups, couples, etc.)
Internship supervision must be conducted in person (i.e. cannot be done virtually by video)
Group therapy/leading group sessions required
Student is not allowed to be paid
Please expound on any special requirements noted above.
Are you seeking regular employment?
Already an employee
If seeking employment, when are you available to start?
What are your career goals after graduation?
Are you 21 years of age or older?
Please send your resume to
Thank you for your interest in Lifeline Youth & Family Services! An Internship Administrator will review your responses to the questionnaire and respond within 7 - 10 business days.
Send me a copy of my responses.
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