Form Builder

Name

Phone number

Student email address

School currently attending

What degree will you be awarded

Masters
Bachelors
Associates

What area of study is your future degree?

What is your expected graduation date?

Please check which category applies to you

Student: Someone who is required to perform a given number of service hours in order to meet a school requirement
Intern: Someone who earns course credit for on-site work experience with Social Services while attending a school of higher education
Collaborative Student: Someone who has completed (or will complete before beginning internship) the NC Competencies of Child Welfare Class

School Intern Liaison Name

School Intern Liaison email address

Internship hours required per week

Internship hours required for semester

What area of DSS are you interested in for your internship (check all that apply)

What days are you available (check all that apply)

What times are you available (check all that apply)

Desired start date:

Expected end date

What are the requirements of the field supervisor?

BSW
MSW
N/A

Why do you want to intern at Catawba County Social Services? Please include professional development goals and objectives you seek to accomplish.

What classes are you currently taking toward your degree?

Will you be seeking employment in Catawba County immediately following your internship/ graduation?

Yes
No

Today's Date:

REMEMBER: Inclusion of your resume and school internship requirements is mandatory for you to be considered for an internship. Please send a copy of your resume and internship requirements to Lindsay Mitchell LMitchell@catawbacountync.gov within 48 hours of completing this application. If these documents are not received within 48 hours, your application will not be considered.

Catawba County is an equal opportunity employer. Discrimination because of race, color, religion, sex, handicap, sexual orientation or national group is prohibited.

The above information is true to the best of my knowledge. I understand that if I give false information, my internship may be terminated. You must check this box or the form will not be submitted.

I agree