Name * First Name Last Name Pronouns Email * Name of University Supervisor First Name Last Name Name of Graduate Program or University Expected Date of Graduation Expected Start Date of Field Experience * Preferred Site Location(s): West Raleigh (Creedmoor Rd) Downtown Raleigh (Washington St) Apex (Hunter St) Chapel Hill (Cloister Ct) Virtual (Telehealth only) East Raleigh (Dresser Ct) Midtown (Benson Dr) North Durham (Guess Rd) Southern Village (Market St) North Raleigh (Professional Ct) Garner (US 70 Hwy W) South Durham (Lyckan Parkway) Pittsboro (Hillsboro St) Describe any student organizations, job experiences, additional course work (undergraduate or graduate), skills,s degrees, certificates or licenses you have that will support you during this internship. Describe your professional goals. Include the experiences you are hoping to gain through an internship program. How does Three Oaks fit with your professional aspirations? Desired Client Population(s): Children Teens Young Adults Older Adults Couples Counseling Family Therapy Group Work Trauma LGBTQIA+ Life Transitions Work-Life Balance Eating Disorders Grief & Loss Anxiety Depression Substance Use Other I am willing to commit to working with Three Oaks for both the fall and spring semesters of my internship if accepted to the program. Yes No Thank you! We have received your request. You should hear back within 3 business days.
