INTERNSHIP APPLICATION

INTERNSHIP APPLICATION

Thank you for your interest in becoming a Washington Area clinical intern and/or volunteer. Our program receives numerous requests for internship placement each year. To protect the integrity of our program and services, and ensure the safety of all involved, we have developed an internal screening process to ensure prospective interns meet certain health, safety, and training criteria, and have the availability to commit to the full internship experience. When you complete the application below, a member of our team will review your information to ensure that mutual expectations align.
At this time, our program accepts interns for the Fall, Summer, and Spring semesters. We do not accept interns mid-year. Interns are typically accepted in cohorts and are expected to continue with the program for a preset duration with their cohort.
Washington Area Clinical Center Practicum and Internship Requirements
To be eligible for an internship or practicum, you must:
1. Must be enrolled in an internship and/or practicum course from an accredited university
2. Must be available M-F during the hours of 9 am - 5 for clinical supervision
3. Must be available 1x per month for a monthly staff meeting (Tuesdays or W @ 9 am or 12 noon)
4. Must be able to perform at least 9 hours of services per week of which 7 hours per week shall be in-person
5. Must be able to be supervised by an LCPC, LCSW-C, LCMFT, or CPNP
6. Must be at the Practicum Level (Some prior experience is required)
Supervision

Most training programs require students to receive an average of 100 supervision hours and between 300-500 hours of supervised clinical hours. Washington Area Clinical Center is able to offer an average of 9 hours per month of clinical supervision as a combination of individual, group, and live supervision.

Interns must be able to provide at least 3 hours of onsite (in-person) clinical services. When performing on-site services, Interns will receive up to 3 hours of live supervision.

Our agency only accepts interns who are able to perform services over a 1 year period.
Required Information

You will not be able to submit this package without the following required information:
Interns, Volunteers, and Students

1. Program/School Site Supervision Forms (please complete all sections except for sections to be completed by the site)

2. Program/School Site requirements

3. Student Liability Insurance

4. TB Screener (If applicable. Please complete the risk assessment first to determine if testing is required)

5. Copy of Resume

6. Consent for Background Check

Staff Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Personal Email*
example@example.com
Personal Cell Phone Number*
Please enter a valid phone number.
Google Voice Number for Patients (If applicable)
Please enter a valid phone number.
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.

Health Information
Please list any allergies you may have
COVID- 19 Vaccine
Please upload a copy of your COVID Vaccination Card or Proof of Vaccine*

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Baseline Individual TB Risk Assessment

Please answer the questions below. Your answers to the questions will determine whether you are required to receive additional TB testing, per CDC guidelines. If you are required to receive additional testing, NMCC-WACC reimbuse your for the cost of testing.
Please Upload a Copy of Your Completed TB Screening Questionnaire*

WACC reimburses staff for the cost of TB-testing, is a test is indicated. Please submit a receipt with your application. Most CVS pharmacies perform TB testing for approx. $60
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Professional Profile

Please answer the following questions thoughtfully as they will be used to construct your profile on the website.
Please share your experience working with diverse patients and colleagues. Have you ever received training in cultural competence? If you would like to share anything unique about your background or professional experience, please do so.
Who is your ideal client? What populations excite you?
What treatment setting have you previously worked in?
List any professional highlights that you may have (e.g. research, memberships, certifications)
Please attach a professional headshot (clear, front-facing, smiling)*

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Final Steps
Thank you for submitting a full and completed package. Once your information is reviewed, a member of our team will contact you if additional information is needed. If you are missing documents or have not completed the necessary steps to submit the required information, do not submit this application. Placement decisions are based on numerous factors including experience level, client caseload waiting lists, staffing needs, etc.Stop, obtain the necessary information and return to complete the package. Our team holds packages for up to 1 year. If you are not offered an internship in this cohort, we may contact you in the future if a space becomes available.
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INTERNSHIP APPLICATION

Washington Area Clinical Center Practicum and Internship Requirements

Required Information

Staff Information

Internship/Practicum Screening Questions

BACKGROUND CHECK

Professional Liability Insurance

Health Information

COVID- 19 Vaccine

Baseline Individual TB Risk Assessment

Professional Profile

Personal Profile

Final Steps