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Internship Application

The mission of Affirmations is to provide a welcoming space where people of all sexual orientations, gender identities & expressions, and cultures can find support and unconditional acceptance, and where they can learn, grow, socialize and feel safe. We accept Intern Applications from both undergraduate and graduate students.

Preferred Name

First Name

Last Name

Legal Name

First Name

Last Name

Date of Birth:

Gender Pronouns

These are the pronouns you prefer that other people use when referring to you. For example, if you use she/her/hers pronouns, we would say "She applied to be a counseling intern"

Phone Number

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

School/University:

Academic Degree Program:

Start Date:

This is the date you would like to begin your internship.

End Date:

This is the date when you would like to end your internship.

Proof of ID

Please provide a copy of your State ID or Driver's License. Uploading an image of State ID/Driver’s License grants consent to Affirmations’ to perform Background Check.

Cover Letter

Resume/CV

Goals and Work

Please detail your goals and work that you wish to achieve during your internship in a one-page summary.

Describe any experiences you feel may apply to your chosen internship role:

Example: Please describe your experience with one-on-one therapy and/or group support if you are applying for Counseling.

Describe your knowledge of LGBTQ+ Communities:

The LGBTQ+ Community is a diverse and intersecting group of folks. Please describe your understanding and interactions with the Community.

Affirming Emergency Contact Information:

First Name

Last Name

Phone Number

Relationship

Additional information/comments:

Media Release Agreement Signature

I grant permission to Affirmations or its assigns, to use in print, electronic, video, or audio format my name, voice, image or likeness of my minor child or myself. I, on behalf of myself, my child and our heirs and assigns, release Affirmations and its assigns from any liability or claim arising in any way from any use of said name, audio, image, or likeness, including but not limited to claims with respect to copyright ownership and publication, express or implied inaccuracies, disclosures, innuendo, or any claim for compensation related to the use of said audio, image, or likeness.