Student Intern Application

Thank you for your interest in interning at ECC!

Please complete the form below and we will get back to you soon!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

University *

Degree You Are Seeking *

University Advisor *

Expected Graduation Date *

Internship Start Date/End Date *

Number of Total Direct Hours Needed *

Number of Total Indirect Hours Needed *

Number of Weekly Individual/Triadic Supervision Hours Needed: *

Number of Weekly Group Supervision Hours Needed: *

Please list any university grants that you are receiving/expect to receive related to internship *

Please list any specialty track(s) *

If you have a specialty track (or other university requirements), please fill in the number of hours needed in each area based on your track.

Adults *

Child/Play Therapy *

Adolescent *

Group *

Specialty University Coursework Completed *

Animal Assisted Therapy Play Therapy Group Adolescent

Please list any other specialty coursework *

Have you previously seen clients in an office-based setting (e.g. practicum)? *

Yes No

Please list any equine experience including any current certifications held (e.g. PATH Intl., EAGALA, CHA, etc) *

Please describe your preferred client population(s): *

Are you seeking a part-time or full-time internship? *

Please list your availability M-F to see clients between 10am-7pm. *

Why do you want to intern at ECC? *

Please list three references including the reference's name, affiliation, phone number, and email address *

Submit