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 *
Phone Number *
Name of school or university
Discipline *
Program(s) of Interest *
Required
How many hours per week does your internship require? *
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
AM (8:30-11:30AM)
PM (12:15-3:15PM)
Notes regarding availability
Desired start date of internship experience *
MM
/
DD
/
YYYY
Desired duration of internship experience *
Required
Please describe the requirements of your internship *
Please briefly describe why you would like to complete and internship at the EEU *
A copy of your responses will be emailed to the address you provided.
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