Georgia HOPE Internship Employment Interest Form
First Name *
Your answer
Last Name *
Your answer
Preferred Name (if different from above)
Your answer
Email *
Your answer
Phone number *
Your answer
What city do you currently reside in? *
Your answer
What state do you currently reside in? *
Your answer
What degree are you pursuing? *
Your answer
Please describe in detail the requirements of your practicum and/or internship that you are seeking to complete at Georgia HOPE. *
Your answer
What is the total length of your practicum and/or internship? Please include begin and end dates. *
Your answer
Please list the number of direct vs. indirect client hours needed. *
Your answer
Which of the following does your program require during your internship? *
Required
Interest in Community-Based Position: *
Georgia HOPE is primarily a community-based provider, which means that the large majority of our services occur in the homes of those we serve. Are you willing conduct appointments in the homes of our clients?
Does your program allow you to deliver services independently (one-on-one with client/family)? *
What hours are you interested in working? *
Choose all that apply.
Required
What population(s) do you prefer to work with? *
Required
Will you require on site clinical supervision throughout your practicum and/or internship? *
Please list the number and frequency of on-site clinical supervision hours required. *
Your answer
Is dyadic clinical supervision acceptable for your program? *
Is web-based video clinical supervision acceptable for your program? *
Please list the degree, credentials, and/or years of experience required for the on-site clinical supervisor. *
Your answer
Does your program require additional courses, testing, or registering for the on-site clinical supervisor? *
Please list your expected graduation date: *
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Which counties are you willing to drive to in order to meet with clients in their homes? (please choose all that apply) *
Required
How did you learn about Georgia HOPE? *
If referred by a Georgia HOPE Employee, please list the Employee's name below.
Your answer
Please copy and paste your resume here *
Your answer
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