Clinic Support Intern Application

Personal Information

Legal First Name and Last Name(Required)

Please double check your spelling and include your full legal name. We will use the spelling provided for your background check.

Preferred Name

Preferred Pronouns

I identify my gender as:(Required)

What is your race/ethnicity?(Required)

Please list all languages spoken.(Required)

Date of Birth(Required)

Primary Phone Number(Required)

Mailing Address(Required)

City / State / Zip(Required)

Email(Required)

Enter Email Confirm Email

Please provide your preferred email address, this needs to be the address that is frequently used and checked.

Emergency Contact Name(Required)

Emergency Contact Phone(Required)

Relation to Emergency Contact(Required)

Internship Requirements

University and program attending(Required)

Which type of internship are you applying for?(Required)

Clinical Internship (Masters Level)

Clinic Support Internship (High-School or Bachelors Level)

Other

When are you expected to start and what is the length of your internship/practicum? How many hours does your internship or practicum require for completion?(Required)

We require all incoming interns and practicum students to complete at least 100 hours at Calm Waters.

Legal History

Have you ever been charged with, plead guilty to or been convicted of a criminal offense?(Required)

Yes

If yes, please explain

We require all volunteers, interns and practicum students to complete a background check before starting their work. Are you a legal U.S. citizen with a valid license and social security number?(Required)

Yes

Other

What connects you to our mission?

What employment or work experience do you feel would help you relate to the Calm Waters mission?(Required)

Please give us the top three reasons you would like to complete your practicum/internship with Calm Waters:(Required)

What would you say is the biggest loss you have experienced in your life?(Required)

Reference #1 Information

Full Name(Required)

Relationship(Required)

Phone Number(Required)

Reference #2 Information

Full Name(Required)

Relationship(Required)

Phone Number(Required)

Just a couple more things...

How did you hear about Calm Waters?(Required)

What is your t-shirt size?(Required)

Calm Waters t-shirts are distributed once volunteer training is completed.

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Calm Waters Clinic Support Internship Application

Personal Information

Internship Requirements

Legal History

What connects you to our mission?

Reference #1 Information

Reference #2 Information

Just a couple more things...

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