EmailMeForm
Internship Application
Application for Interns
Name:
First
Last
Phone:
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Email:
Current College or University:
Degree Pursuing:
Total hours needed for internship:
Please all semesters requested?
Fall
Spring
Summer
First day available for internship:
MM
/
DD
/
YYYY
Last day available for internship:
MM
/
DD
/
YYYY
Weekly availability (day of the week and time of day):
What type of internship or Field Placement are you requesting?
Direct Care
Professional Level
Administrative
Please specify which Professional field?
Speech and Language Pathology
Occupational or Physical Therapy
Special Education
Social Work
With which of the following age ranges are you looking for experience? (select all that apply)
2-5
6-10
11-15
16-21
Over 21
Please upload your current resume and a cover letter further explaining your interest in Vista.