Thank you for your interest in our Internship Program at Healing Strides. This is the first step in applying to be accepted, so please be sure to input clear details.

First Name *

Last Name *

Phone *

Email *

Address *

Street Address

City *

State *

Country

Postal code *

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This internship/application is for what year?

This application is for what part of the year? *

Please explain "other"?

Spring & Fall, Multi year, etc.

General start date of Intership requested? *

What school will this internship be through?

(school you are currently attending)

What level of schooling are you working on? *

Associates

Undergraduate

Graduate

Major? *

If you have a minor, please put that as well.

Specialization?

Sometimes certain classes require internships, if that applies to you:

What is your class & generally what is it about?

If unsure, pleaseask your professor for more information.

Healing Strides does offer oversight by one of our LCSW's on staff for Graduate level interns or PATH CTRI Mentor oversight if needed. Oversight is not guaranteed and will be approved on an individual basis, after full application is completed.

Will you need oversight? *

Please list at least 2 (3 is great!) professional/educational references.

Reference number 1: *

References name, relationship to you, phone, and email.

Reference number 2: *

References name, relationship to you, phone, and email.

Reference number 3:

References name, relationship to you, phone, and email.

Previous experience (work, internship, etc.)

Organization *

Contact information for previous experience? *

Supervisors name, phone, address.

Job title and responsiblities? *

START and END dates of this experience? *

Reason for leaving? *

Military Service

Branch? *

Time of Service? *

start and end date

Rank at discharge: *

Type of discharge: *

If "other", please explain:

Captcha

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to an internship, I understand that false or misleading information in my application or

interview may result in my release.

By signing below, I am stating all information is true and to the best of my knowledge: *

Clear

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