2026-2027 JSSA Internship Application

2026-2027 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 NameLast Name
Name of School
Program

Other
Have you or a family member received or are currently receiving Mental Health services at JSSA?
If a family member, what is their name?
When did these services begin and end? Indicate approximate date/s if you dont have the specific dates. If currently receiving services, indicate that services are ongoing.
How did you hear about JSSA Internship Program?
Practicum Student (1st year)
Internship Student (2nd yr)
**PLEASE NOTE THAT IN ORDER TO DO AN INTERNSHIP AT JSSA, THE STUDENT MUST RESIDE IN MARYLAND, DC OR VIRGINIA.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
University Field Liaison Name (if applicable)
Liaison Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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

Cancelof
Number of direct and indirect contact hours required by university
Timeframe of internship (start date)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Timeframe of internship (end date)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you available to provide 2 full business days to your internship?

NO Please explain
How did you hear about JSSA?

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:

Other
Please provide additional information about yourself that you think is crucial for JSSA to know:
Should be Empty:

2026-2027 Graduate Internship Application

Please submit two (2) letters of recommendation to Kiran Dixit at kdixit@jssa.org within 2 weeks of your application submission.