The Social Therapy Group and East Side Institute for Group and Short Term Psychotherapy



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The Social Therapy Group and

East Side Institute for Group and Short Term Psychotherapy

INTERNSHIP APPLICATION



Student Information


Date:
Name:

Address:

City: State/ Province:

Zip/Postal Code: Country:

Email:

Home Phone: Work Phone:


Will your internship satisfy requirements for your university?

(Circle one) YES NO
If specific guidelines are required what are they? if not, what activities are you doing? Please include # of hours and nature of activities.

_________________________________________________________________________________________________________________________________________________________________________________________________________
EDUCATION (BACHELOR’S AND ABOVE)
Institution:
Years Attended: Degree:
Department and/or Concentration:

Institution:
Years Attended: Degree:
Department and/or Concentration:

Institution:
Years Attended: Degree:
Department and/or Concentration:

PROFESSIONAL EXPERIENCE (INCLUDING INTERNSHIPS)

Institution:


Title/Position:
Dates:

Institution:


Title/Position:
Dates:


PROFESSIONAL INTERESTS


Briefly describe your interests and how they led you to want to study at the Institute.

Are you familiar with postmodern/performance-based approaches to psychology, philosophy, social work, education? Have you studied positive psychology, humanist psychology, narrative approaches or social constructionism?
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