Internship Inquiry Form
Please provide your details and interest in the internship opportunity.
Name
*
First Name
Last Name
Pronoun Preference
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
University
*
Degree
*
Dates of internship placement
*
Schedule (Days of the week and hours expected to be at Anuvia)
*
Primary program(s) of interest.
*
Outpatient Substance Use Group
Outpatient Mental Health Individual & Group
Outpatient Adolescent Individual & Group Therapy
Inpatient Treatment
Recovery Court
Marketing
Finance
Other
When do you need a final answer for approval or denial of internship?
*
A Brief statement about your professional interest.
Please upload your resume.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional University Documentation
Browse Files
Drag and drop files here
Choose a file
Example(s): Affiliation Agreement; Syllabus; Learning Agreement; Internship Requirements.
Cancel
of
Save
Submit
Should be Empty: