Application Form | Cuyahoga County Board of Developmental Disabilities

Name *

Phone Number *

Email *

College/University Name *

Academic Department *

Degree Sought *

Academic department contact name and phone number

Approximate start and end dates of internship/field placement:

(if applicable)

Required professional credential of the field supervisor:

(if any)

Please provide a brief overview of your interests and any relevant experience that you may have as it relates to this field placement: *

Which type of internship are you interested in? (Select the one that best fits your interests and learning goals.)

Behavioral health (counseling, psychology or clinical social work)
Occupational or physical therapy
Speech language pathology
Early childhood
Community development (community-based social work practice)
Business engagement (strategies for competitive employment)
Other (note in previous question)

Please click “submit” upon completion of this form. Your request will be routed to the appropriate department which will review your submission and contact you if a placement can be supported. Please be patient. It may take up to two weeks for a response.

Questions? Call Ana Vargas at 216-736-2692.

*

Student Internship Application Form