MFT OR CPC STUDENT INTERNSHIPS

Our practice is currently accepting student interns. Please fill out the information below and we’ll be in contact with you shortly.

Before applying, please click here to read about the internship program as well as applicant criteria.


APPLICATION
Name *
Name
Street address, city, state, and zip code.
Phone *
Phone
Are you currently doing an internship or practicum at another site? If yes, what is the other site?
Have you completed a practicum or internship at another site? If yes, what was the other site?
Available Days *
Red Rock Counseling is based on a private practice model, giving graduate student interns 2 consecutive days in an office. What days can you be available to see clients? 
Nights and Weekends *
Are you available to see clients in the evenings and weekends? 
Please explain your schedule if necessary:
EDUCATION
Name & Dates
Name & Dates
Name & Dates
REFERENCES
Full name, relationship, telephone, email, company, address.
Full name, relationship, telephone, email, company, address.
PREVIOUS EMPLOYMENT
Phone *
Phone
Contact *
May we contact your previous supervisor for a reference?
Phone *
Phone
Contact *
May we contact your previous supervisor for a reference?
MILITARY SERVICE
Leave blank if you have no military service.
DISCLAIMER & APPROVAL
I certify that my answers are true and complete to the best of my knowledge. If this application leads to performing my internship with Red Rock Counseling, I understand that false or misleading information in my application or interview may result in my release. I have reviewed the requirements of graduate student intern therapists and agree to those requirements. *
Name *
Name
Date *
Date