UNC Horizons Program Internship Inquiry

Student Information

Name*

Email*

Phone Number*

School*

Please list the school where you are currently enrolled in.

Degree*

Please list the degree and/or credential you are currently pursuing.

Faculty Liaison*

Name, phone number, and e-mail address of faculty liaison at your school.

INTERNSHIP | Start Date*

Please list the when you will need to start your internship.

INTERNSHIP | End Date*

Please list the when you will need to end your internship.

Days Available*

Days of the week you are available for an internship.

Clinical Hours Per Week*

Please list the number of clinical hours per week required for your internship.

Supervised Hours Per Week*

Please list the number of hours of clinical supervision you are required to receive per week.

Supervisor Credentials*

Degree and/or credentials your clinical supervisor must hold.

Additional Information

Any other requirements or stipulations for your internship