> County of San Luis Obispo > Health Agency Services > Drug and Alcohol Services Home Page > Drug & Alcohol Services Internship and Volunteer Application

Drug & Alcohol Services Internship and Volunteer Application

Page 1 of 1
Please select the program you are applying for:
LMFT/LCSW Traineeship
Drug and Alcohol Counseling Certification Internship
Prevention Internship
General Volunteer
First Name
Last Name
Today's Date
Pick date
Email Address
Street Address
Institution/School Currently Attending
Approximate Graduation Date
Pick date
Clear selection
Please mark quarter(s) you would like to intern
Who is your faculty internship director/advisor?
Do you speak a foreign language? If so, which?
Please mark all regions in which you are willing to work:
San Luis Obispo/Coastal
South County
North County
Person to notify in case of emergency Name & Phone Number
Relationship to you
Have you ever been convicted of a crime (including DUI, misdemeanor, felony, sexual offense or other)? If yes, please explain.
Are you currently or have you ever been a client of Drug and Alcohol Services? If Yes, when?
Do you have any limitations on your work schedule (evenings, weekends, other)?
What is your motivation to work in the treatment or prevention of addiction and substance abuse issues?
What do you hope to gain from the experience of working at Drug and Alcohol Services?
What is your experience working in the human services field? (please attach resume)
Reference #1: Name and Contact Number
Reference #2: Name and Contact Number
Additional Comments: