Internships are considered for students who are pursuing a degree in social work or a related field, and for which the internship is an academic requirement. Students must consult with their respective Field Office/Faculty Advisor for approval, prior to submission of inquiry form.
INTERNSHIP INQUIRY FORM
* Indicates a required field
                 *First Name:    
                 *Last Name:    
*Address:    
*City:    
*State:  
 Phone:  
 Cell:  
                 *Email:      
 *Gender:  
* Race:  
 EDUCATION INFORMATION
                 *College/University:    
                 *Field of Study:    
 *Type of Degree:  
 *Current Year of Study:  
                 *Date of Anticipated Graduation:    
CONTACT FOR SITE APPROVAL (REQUIRED PRIOR TO SUBMISSION) 
                 *Faculty/Field Advisor Name:    
 *Phone:  
 *Email:      
SEMESTER & YEAR REQUESTED 
Fall:
Spring:
Summer:
*Total # of Credit Hours to be completed:  
Note: Our internship program is only for students seeking college credits and is not a volunteer opportunity.  You must be working with an academic advisor and/or taking a course that will coincide with this internship!  If the total number of credits is not known at this time, please enter TBD. If this request is not for college credits, please do not submit this form.
                 *Number of Hours per week:    
Note: If the total number of hours per week is not known at this time, please enter TBD.
ACADEMIC PROGRAM 
If your academic program has any restrictions, please explain:
 
Please indicate how internship will be evaluated (i.e site visits, journals, papers):
 
Please list the specific requirements as outlined in your Field Placement Manual or Learning Contract:
What do expect to gain from your field placement experience (educationally, personally, professionally)?
OFFICES AND FACILITIES OF INTEREST
*Select offices below for internship placement.  (Placements are considered based on availability)






 
                 *Have you already been in contact with someone at DCF regarding placement?

 
If yes, please provide name for contact: