* indicates required field * First Name * Last Name * Email Address * Confirm Email Address * Type of Internship GraduatePost-Masters Please complete the fields only for your type of internship. Graduate Interns Name of University Degree Type CounselingPsychologySocial WorkOther If you selected "Other," what is your degree type? Expected Internship/Practicum Start Date (MM/DD/YYYY) Anticipated Internship/Practicum End Date (MM/DD/YYYY) Does your program require: Video/audio taping of sessions YesNo Types of Therapies Individual TherapyFamily TherapyGroup Therapy Post-Masters Interns License Type LPC-ILMSW Are you currently in supervison? YesNo If yes, how many hours have you obtained? * Please attach a PDF of your resume to this application. Comments/Questions