Internship Application Name* First Last Email Address* Cell Phone*Date of Birth* MM slash DD slash YYYY Internship type:* MSW First Year MSW Second Year BSW Senior Counseling Psychology Other Preferred orientation group:* May September January Date available to start:* MM slash DD slash YYYY Expected end date:* MM slash DD slash YYYY Total number of hours needed:* Preferred schedule days/times:* Morning shifts 8:00am-4:00pm, afternoon shifts 2:30pm-10:30pm. One weekend shift per month required.Do you have a criminal record?* Yes No If yes, please explain:* Employment/Experience HistoryUpload resume and cover letter* Drop files here or Select files Accepted file types: doc, docx, pdf, txt, rtf, , Max. file size: 50 MB. Previous internship experience:*Include organization, dates, and responsibilities.Briefly describe experiences (education, family special training, etc.) you feel have prepared you for an internship at The Bridge:*Please describe your interests, hobbies, or skills you feel may be of interest to adolescents:*Please describe what you hope to gain from you experience at The Bridge, as well as what you hope to offer:*School InformationIf your internship is for school credit, please complete the following: School* Field Liaison* First Last Field Liaison Email Address* Field Liaison Phone Number*In Case of Emergency ContactEmergency Contact Name* First Last Relationship* Emergency Contact Phone Number*NameThis field is for validation purposes and should be left unchanged. Δ
