Internship/Practicum Application

Name:*
Address:*
Phone:*
E-mail address*
College/University Attending:*
Internship or Practicum?*
Major:*
Are You a Current Glade Run Employee:*
- Yes
- No
Total Number of Internship Hours Requested:*
Intership Start and End Dates:*
Advisor's Name and Contact Information (email and phone):*
Please Upload or List Internship Requirements
Max. file size: 128 MB.
Please Upload or List Internship Requirements
Please Indicate Level of Internship Requested*
- Bachelor's Level
- Master's Level
Level of Supervision Required:*
Degree and Level of Experience Required for Supervisor:*
Please List Your Internship Availability (Dates, Days, Hours):*
With What Ages Groups/Genders Do You Prefer to Work:
At Which Location(s) Are You Interested in Interning:*
Choose all that apply. For multiple selections press CONTROL and click.
Current/Most Recent Employer:
Please list: Employer Name, Address, Phone, Job Title, Supervisor Name, Date Started, Ending Rate of Pay, Work Performed, May We Contact (yes or no)
Employer #2
Please list: Employer Name, Address, Phone, Job Title, Supervisor Name, Date Started, Ending Rate of Pay, Work Performed, May We Contact (yes or no)
Please Upload a Current Resume:*
Max. file size: 128 MB.
Signature
Type Signature Here*
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