ETSU COUNSELING CENTER

PRACTICUM/INTERNSHIP APPLICATION FORM

DATE:

PHONE:

EMAIL ADDRESS:

 

 

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NAME:

 

ADDRESS:

 

GRADUATE MAJOR & CONCENTRATION:

 

INTERNSHIP SEMESTER(S): SPRING 2019_______  SUMMER 2019_______ FALL 2019________

(check all that apply)

 

 Please respond to the following items (on separate paper, please):
1. Briefly (1-2 paragraphs) explain your present counseling/psychology theoretical orientation.
2. List and briefly describe all relevant clinical experience.
3. Write a statement concerning your career goals and how you hope this internship experience will support your goals.
4. Reflect on the following question: In what way have you explored your own personal growth and development and how will this impact the way you work with clients?

 

Please also provide:
a) three (3) recent professional/academic references;
b) a copy of your current resume.

 

 

All application material may be turned in to Rebecca Alexander, LMFT, Training & Clinical Director, either by email (alexanrl@etsu.edu) or hard copy to ETSU Counseling Center, Nell Dossett Residence Hall, 3rd Floor.