Counseling Intern Application

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Graduate Counseling Student Internship Application

Please complete the form below and we will get back to you soon!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Internship Information

University *

Degree You Are Seeking: *

Masters Doctoral

University Advisor Name *

Expected Graduation Date: *

Total Number of Direct Hours Needed: *

Number of Weekly Individual/Triadic Supervision Hours Needed: *

Please list any university grants that you are receiving/expect to receive related to internship *

Internship Start/End Dates: *

Total Number of Indirect Hours Needed *

Number of Weekly Group Supervision Hours Needed: *

Coursework/Specialty Information

Please list any specialty track(s): *

If you have a specialty track (or other university requirements), please fill in the number of hours needed in each area based on your track.

Adults *

Child/Play Therapy *

Adolescents *

Group *

Specialty University Coursework Completed: *

Animal Assisted Therapy Play Therapy Group Adolescent

Please list any other specialty coursework: *

Experience and Interests

Have you previously seen clients in an office-based setting (e.g. practicum)? *

Yes No

Please describe your preferred client population(s): *

Please list any equine experience including any current certifications held (e.g. PATH Intl., EAGALA, CHA, etc) *

Scheduling and Availability

Are you seeking a part-time or full-time internship? * *

Part-Time Full-Time

Please list your availability M-F to see clients between 10am-7pm. *

Why do you want to intern at STEPS? *

Please list three references including the reference's name, affiliation, phone number, and email address" *

Submit

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Telephone

682-219-8733

Email

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