Internship Application | People Incorporated

* Required Fields

Step 1: Contact Information

First Name *

Last Name *

Present Address

Address 1 *

Address 2

City *

State *

Zip *

Email *

Phone - Primary *

Phone - Secondary

Permanent Address

Address 1 *

Address 2

City *

State *

Zip *

Step 2: Educational Background

Example 1

College/University

Address

Major

Minor

Date when degree was conferred or anticipated

Example 2

College/University

Address

Major

Minor

Date when degree was conferred or anticipated

Example 3

College/University

Address

Major

Minor

Date when degree was conferred or anticipated

Describe other practical experience you have in working with people who have either mental health or chemical abuse issues (e.g. volunteer experience, previous practicums, personal experience, etc.)

List coursework relevant to this internship

Step 3: Professional Experience

Example 1

Employer *

Dates of Hire:

From * To *

Responsibilities *

Address *

Immediate Supervisor *

Reason for Leaving *

Example 2

Employer *

Dates of Hire:

From * To *

Responsibilities *

Address *

Immediate Supervisor *

Reason for Leaving *

Step 4: Practicum Information

Required length of practicum (hours) *

Start Date *

End Date *

School Field Placement Coordinator *

Direct Phone Number *

Are there days of the week you are not available?

If your internship supervisor at People Incorporated is required to have a certain type of licensure, please specify what type.

Step 5: References

Please provide the names of three people who can speak to your professional, personal or practical experience related to working with or knowing people who have co-occurring disorders.

Reference 1

Name *

Years Known *

Relationship to you *

Phone *

Reference 2

Name *

Years Known *

Relationship to you *

Phone *

Reference 3

Name *

Years Known *

Relationship to you *

Phone *

Step 6: Additional Questions

The final step in requesting an internship placement at People Incorporated is to answer the following questions:

How will completing an internship at People Incorporated advance your professional career goals? *

What are some areas of growth you would hope to improve during your internship? *

What reservations do you have about working with this population or in completing an internship with us? *

What strengths would you bring to the internship? *

In your opinion, what are some of the greatest challenges people with mental health issues face on a day to day basis? *

How would you incorporate your coursework and/or supervision into your daily work with clients and various co-workers? *

Thank you for completing this application.