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

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.

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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?