Intern Interest Survey - Ozark Guidance
Intern Interest Survey
Name: ___________________________________________________________________________
University: ________________________________________________________________________
Degree Sought: ________ BSW _________ MSW ________ Master of Counseling
Anticipated Graduation Date:_________________________________________________________
Are you able to travel between internship sites? __________________________________________
Are there any personal responsibilities, limitations, or concerns you have which should be taken into consideration when making your placement including hours/days of availability:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
What are your plans after graduation? (Where do you plan to work, etc.)_______________________
________________________________________________________________________________
_________________________________________________________________________________________
Field Placement General Interests: (Check all that apply)
( Elementary ( Middle School ( Junior High ( High School ( Adult ( Day Treatment ( School Based ( Outpatient
( Carroll County ( Washington County ( Western Benton County (Siloam Springs) ( Eastern Benton County (Bentonville/Rogers) ( Madison County
Please review the description of our openings on our website. Of those openings, choose your top 3 placements of interest (in order of preference). Please do not include placements for which you are not qualified (e.g. Social Work placement when you are a Counseling student, etc.).
1.____________________________________________________
2.____________________________________________________
3.____________________________________________________
Please list any course work or experiences (not otherwise listed on your resume) that would be relevant to the departments chosen above.______________________________________________
________________________________________________________________________________
________________________________________________________________________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.