Internship Request Form
Please complete this form if you have interest in completing an internship in an EEU classroom that includes children with and without disabilities and would like to work collaboratively with Special Education Teachers, Occupational or Physical Therapists and Speech Language Pathologists.
Email address *
Name *
Your answer
Phone Number *
Your answer
Name of school or university
Your answer
Discipline *
Program(s) of Interest *
Required
How many hours per week does your internship require? *
Your answer
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
AM (8:30-11:30AM)
PM (12:15-3:15PM)
Notes regarding availability
Your answer
Desired start date of internship experience *
MM
/
DD
/
YYYY
Desired duration of internship experience *
Required
Please describe the requirements of your internship *
Your answer
Please briefly describe why you would like to complete and internship at the EEU *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of UW. Report Abuse - Terms of Service