internship request form

Name *

First Name

Last Name

Will you reside in the Portland Metro area at the start of your internship? *

Yes

No

Is this program CACREP Certified? *

Yes

No

Unsure

This program is:

Fully Online

Hybrid

In Person

Are you able to commit to 2 days / week at this placement? *

Yes

No

Will you have completed diagnosis and assessment courses by the start of your internship?

Yes

No

Unsure