Fillable Olmsted County Health, Housing and Human Services INTERNSHIP

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Olmsted County Health, Housing and Human Services INTERNSHIP

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Olmsted County Health, Housing and Human Services
INTERNSHIP APPLICATION
1 | Page
* By filling out this application, the applicant is verifying the information provided to be true and accurate.
I. Identifying Information
A. Name: Date:
B. Mailing Address:
City:
State: Zip: County:
C. Email Address: Phone:
D. School:
Major: Year in School:
E. Advisor’s Name:
Email:
Phone:
F. Emergency Contact: Name:
Phone:
G. Current Degree / Licensure (if applicable):
II. Internship Request
Type of Experience: Shadowing Field Experience
Internship: BSW Masters SW Clinical Masters Foundation
Number of Hours Requested:
A. Why are you interested in an internship with our agency?
B. What are your expectations of the internship? What do you hope to learn?
Olmsted County Health, Housing and Human Services
INTERNSHIP APPLICATION
2 | Page
C. What experiences, volunteer or paid, have you had that relate to this line of work?
D. What are your long-term professional goals?
E. Please indicate any involvement (past or present) that you, family member, friend, partner or acquaintance
has had with the Criminal Justice System, Probation, or any services in Adult and/or Child & Family Services
that could create a conflict of interest for you.
(This would not necessarily preclude you from an internship with OCHHH).
Yes No N/A
F. When would you like to intern?
1. Spring Semester ……………………………………………. (Jan to May)
2. Summer ……………………………………………………..... (May to Aug)
3. Fall Semester ……………………………………………..... (Aug to Dec)
III. Area(s) of Interest: (Please check the box in front of your area(s) of interest & indicate your areas of
interest in the order of placement preference) We will do our best to accommodate.
# DFO Community Corrections: Juvenile Probation Adult Probation Victim Services
# Children & Family Services # Public Health
Child Welfare Clinic Services
Child Protection School Health
Early Intervention Home Visiting
Youth Behavioral Health Adult Services
Child Foster Care / Child Care Licensing
Afterhours Social Workers
#
Adult & Family Services: Adult Protection Adult Foster Care Aging & Care Coordination
Housing Services Integrated Behavioral health (Mental & Chemical Health Support Services)
Disability Services (check one): Youth Adult
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Olmsted County Health, Housing and Human Services INTERNSHIP

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Completed 17 January 2021

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