Counseling & Psychological Services

Counseling & Psychological Services

Internship Application

Masters/Doctoral Requirements Remaining
Please indicate your progress on your thesis/dissertation and other program requirements.  

A. Thesis/Dissertation Topic:

B. Dissertation Progress, please check appropriate box(es):

	Working Proposal
	Proposal Approved
	Data Collected
	Dissertation Completed

C. Course Work (date to be completed) 

D. Comprehensive Exam (date to be completed)

Total number of supervised practicum hours you will have completed, including supervision, training, theory, etc.  

Please list all agencies in which you have worked, the number of hours at each and a brief description of your duties. (Example: Agency Name - 20 hours/week, month, year, 400 hours total individual, group, and crisis intervention with adults and children.)

Does your program consider you to be eligible for an internship during the coming academic year (if appropriate).

Yes (please have your training Director complete the attached Certificate of Internship Eligibility & Readiness)

In addition to this application form, the following materials must be submitted.

1. Official Transcripts of all your graduate work.
2. A current resumé.
3. Letters of evaluation from three persons who have observed your academic and applied performance.

Please submit the application when it is completed.