Graduate Internship Application
Thank you for expressing interest in interning at JSSA! Please fill out the application below to start your internship process.
Name
First Name
Last Name
Graduate Student?
Yes
No
Name of Graduate School
Program
Social Work
Counseling
Psychology
Type option 4
Other
Practicum Student (1st year)
Internship Student (2nd yr)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
University Field Liaison Name (if applicable)
Liaison Phone Number
Please enter a valid phone number.
Liaison Email
Do you speak a foreign language(s)? please list.
Please submit two (2) letters of recommendation to Kiran Dixit at kdixit@jssa.org within 2 weeks of your application submission.
Please attach your Resume
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Number of direct and indirect contact hours required by university
Timeframe of internship (start date)
/
Month
/
Day
Year
Date
Timeframe of internship (end date)
/
Month
/
Day
Year
Date
Are you available to provide 2 full business days to your internship?
YES
NO Please explain
How did you hear about JSSA?
Online
Word of mouth
Flyer
Other
Please tell us about what you hope to get out of your JSSA internship.
Please list three goals that you hope to accomplish while interning at JSSA.
Please indicate your interests below:
Addictions/Substance abuse
Advocacy
Case management
Child welfare (abuse & neglect, residential, foster care)
Chronic mental illness
Civil/human rights
Community development/planning
Community organization
Crisis intervention
Service for those with developmental disabilities
Domestic violence/sexual abuse
Dying and bereavement
Services for the elderly
Employee assistance programs
Family services
Family preservation
Group Treatment
HIV/AIDS
Homelessness
Hospice
Individual Treatment
International/refugees
Legislative/political
Management
Medical/hospital
Mental health (inpatient)
Mental health (outpatient)
Offenders, adult
Offenders, Juvenile
Policy Analysis
Service for poor/economically disadvantaged
Program Management
Public health
Religion-based social work
Research
School social work
Social planning
Special eductoin: LD/ED
Other
Please provide additional information about yourself that you think is crucial for JSSA to know:
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