Alliance For Children Internship Application Form

Alliance For Children Internship Application
Name:*

First Name Last Name
Phone Number:*

Area Code Phone Number
E-mail Address:*
example@example.com
Address:*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Resume:*
Picture (headshot with white background):*
Please use a headshot wit a white background
Driver's License/Passport/Identification Card:*
Language(s): *
TShirt Size:
Type of Internship Interest:*

EDUCATIONAL INTERNSHIP: Internship REQUIRED to complete a degree at a college or university, to include independent study, courses and department field placements; standardly over one or two semesters.EXPERIENTIAL INTERNSHIP: Internships associated with someone who would like professional growth likened to an educational internship, but NOT associated with degree requirement; 3-6 month commitment required.
How many semesters are you able to commit to this internship

1 semester max2 semesters max2 or more semesters
Please indicate the degree program in which you are currently enrolled/pursuing:*

High School DiplomaBachelors DegreeMasters Degree
ARCHIVED DATA PROGRAM OF INTEREST

FAMILY ADVOCATE PROGRAM: FULL FOR SPRING 2023 Specially trained team of Family Advocates help navigate children and their protective family members through the overwhelming process of dealing with a case of child abuse from initial outcry all the way through prosecution, our Family Advocates are there to help families understand the process and successfully access needed resources in our community. Families are referred to our program through our partner agencies. Case management may include resource referrals, court preparation or accompaniment, financial assistance, coordination of emergency needs, or assistance completing Crimes Victims' Compensation applications. Two semester commitment preferred.CLINICAL PROGRAM: MUST BE MASTER LEVEL OR ABOVE Offers both individual and group counseling services to confirmed victims of child abuse and their protective family members. Our clinical counseling staff work closely with clients to determine an individualized treatment program for each child. Counseling modalities utilized include Trauma-Focused Cognitive Behavioral Therapy through individual and group counseling, and Parent-Child Interaction Therapy.CLIENT RELATIONS SPECIALIST PROGRAM: As families become involved with the investigation and our healing services, their experience from entering our family-friendly centers are critical to interventions and healing services. With an emphasis on Trauma Based Relational Interventions (TBRI), interactions with both caregivers and children are a focal point of this program.
PROGRAM OF INTEREST

In the next section, please select your internship program of interest.
Client Relations Specialist Program

CLIENT RELATIONS SPECIALIST PROGRAM: As families become involved with the investigation and our healing services, their experience from entering our family-friendly centers are critical to interventions and healing services. With an emphasis on Trauma Based Relational Interventions (TBRI), interactions with both caregivers and children are a focal point of this program.
Clinical Program

CLINICAL PROGRAM: MUST BE MASTER LEVEL OR ABOVE Offers both individual and group counseling services to confirmed victims of child abuse and their protective family members. Our clinical counseling staff work closely with clients to determine an individualized treatment program for each child. Counseling modalities utilized include Trauma-Focused Cognitive Behavioral Therapy through individual and group counseling, and Parent-Child Interaction Therapy.
Family Advocate Program

FAMILY ADVOCATE PROGRAM: Specially trained team of Family Advocates help navigate children and their protective family members through the overwhelming process of dealing with a case of child abuse from initial outcry all the way through prosecution, our Family Advocates are there to help families understand the process and successfully access needed resources in our community. Families are referred to our program through our partner agencies. Case management may include resource referrals, court preparation or accompaniment, financial assistance, coordination of emergency needs, or assistance completing Crimes Victims' Compensation applications. Two semester commitment preferred.
The next portion is if you are currently enrolled in school:
College / University:
Department/Degree:
Does your internship require your field supervisor to have a specific degree and/or licensure?*

YesNoUnsure
If yes, please list degree requirement and/or licensure requirement:
Total Number of Hours Needed per Semester:
Length of Internship (if an educational internship):

Split Semesters (2 semesters)Block Semester (1 semester)
Terms:

Spring 2023 SemesterSummer 2023 SemesterFall 2023 SemesterSpring 2024 Semester
Start Date:

MonthDay Year
Date
Completion Date:

MonthDay Year
Date
Licensure Supervisor/ Field Liaison's Name:

First Name Last Name
Licensure Supervisor/ Field Liaison's Phone Number:

Area Code Phone Number
Licensure Supervisor/ Field Liaison's Email:
example@example.com
Non Clinical Internship Availability: Please note your schedule availability in the table above. **Center hours are available Monday - Friday, 8:30 AM - 5:00 PM., with some variations between centers. Evening hours are available for interns in the Clinical Department. This allows an understanding of interns general availability.
Availability for non-clinical internship:

Monday morningsMonday afternoonsTuesday morningsTuesday afternoonsWednesday morningsWednesday afternoonsThursday morningsThursday afternoonsFriday morningsFriday afternoons
Clinical Internship Availability: Please note your schedule availability here. Clinical Department hours are traditionally Monday - Thursday from 9:00AM to 7:00 PM

Monday morningsMonday afternoonsMonday eveningsTuesday morningsTuesday afternoonsTuesday eveningsWednesday morningsWednesday afternoonsWednesday eveningsThursday morningsThursday afternoonsThursday eveningsFriday morningsFriday afternoons

Location Preferred:

	Arlington	Fort Worth	Northeast (Hurst)
First
Second
Third
Fourth

Please describe your interest in interning with Alliance For Children: *
Are you currently or have you ever received services through Alliance For Children?*

YesNo
If yes, please explain
References

Please list two (2) references that are familiar with your work life.
I authorize Alliance For Children to contact my personal references listed and understand that Alliance For Children will not be held liable for the release of this information.*

YesNo
Reference 1
Name:*

First Name Last Name
Phone Number*

Area Code Phone Number
Email address:
Relationship: *
Years Known:
Reference 2
Name:*

First Name Last Name
Phone Number*

Area Code Phone Number
Email address
Years Known:
Relationship: *
Emergency Contact
Name:*

First Name Last Name
Phone Number*

Area Code Phone Number
Email
example@example.com
Relationship: *
Background Check Release
I grant permission to Alliance For Children to initiate, via the Department of Family and Protective Services' online self-service system, a Child Abuse/Neglect Central Registry and a Texas Department of Public Service Criminal history check as well as any subsequent checks so long as I am active with the agency. I attest that the information I provide online will be correct and that providing false information is a violation of the Texas Penal Code Section 37.10 and agree to update Alliance For Children with any changes to the information above. I am a prospective intern and concent to release information regarding criminal or abuse history to Alliance For Children. I agree to update Alliance For Children with any changes to the information above.I consent to release information regarding criminal or abuse history to Alliance For Children. I ACKNOWLEDGE I HAVE READ THE ABOVE AND HAVE PROVIDED MY SIGNATURE BELOW.
Have you ever been arrested or charged with a criminal violation of law?

YesNo
Have you been involved in a child abuse investigation?

YesNo
Have you used or sold illegal drugs within the past 5 years?

YesNo
If "yes" to the above questions, please explain:
Signature
Date

MonthDay Year
Date
Should be Empty: