Wayfinders Intern/Practicum Application

Attention Clinical Rehab & Mental Health Students: Wayfinders does not have licensed counselor staff members to meet the requirements for students pursuing the licensure route.

Date * +

Last Name *

First Name *

Academic Standing *

Student ID Number *

Select One: Internship or Practicum *

Major/Program/Area of Study *

Total number of internship/practicum
hours needed: *

Number of hours per week: *

Internship Semester Start *

How long will your internship last? *

Fresno State E-mail Address *

*

Mobile Phone *

Street Address *

Address Line 2

City *

State *

Zip Code *

What interests you in working with Wayfinders for your internship/practicum hours? *

What qualities do you possess that will assist you in working with our program? *

What do you hope to learn by working with us for your internship/practicum hours? *

Have you ever been convicted of a sexual crime or child abuse? *

Have you ever been convicted of a felony? *

If you have a felony conviction, please explain if not please skip to the following question.

Do you give permission to be filmed or photographed and for your name to be used for the purpose of promoting the Wayfinders Program at Fresno State? *

Anticipated Start Date * +

Anticipated End Date * +

Number of hours per week: *

Availability (Provide ALL days/times you will be available to complete hours throughout the week) *

Required: Upload your resume. *

Required: Upload a letter of recommendation from a professional reference. *

Interns and practicum students must obtain First Aid/CPR/AED certification within 30 days of starting their hours with Wayfinders. If you already have this certification, please upload a copy here.

Emergency Contact

First Name *

Last Name *

Phone Number *

Email Address *

Intern/Practicum Supervisor

First Name *

Last Name *

Phone Number *

Email Address *

Agreement

Internship / Practicum Agreement

We want to assure you that we appreciate your contribution to our organization. We are dedicated to ensuring that you have a quality internship experience that is mutually productive and rewarding.

Wayfinders at Fresno State commits to the following:

To provide adequate information and training so you may meet the expectations as described in your intern description.
To explain what is required of you and to support and provide encouragement to help you achieve the desired results.
To provide you with a mentor and supervision meetings and act as a “go to” person.
To treat you with respect and courtesy at all times.
To be receptive to any comments and feedback form all our interns.
To value and recognize our interns as a significant resource in achieving the goals of our organization.

The Intern/Practicum Student commits to the following:

To fulfill my role as outlined in the attached intern role description.
To perform my intern role to the best of my ability.
To follow the organization's policies and procedures.
To meet time and task commitments and to provide sufficient notice when not available.
To act in a way that is in line with the aims and objectives of the organization and that enhances the work of the organization.

Internships simulate employment and provide the opportunity for students to learn by doing. This means you are not a paid employee of Wayfinders and therefore should not represent yourself to other parties as an employee but rather refer to yourself as an intern.

This agreement is binding in honor only, and is not intended to be a legally binding contract between the intern and Wayfinders. Neither party intends any employment relationship to be created now or at any time in the future. This agreement may be cancelled at any time at the discretion of either party.

Confidentiality

For Interns/Practicum & Other Students that are not employees of Wayfinders:

Due to your access to confidential information, all students who wish to gain experience with Wayfinders through internships/practicum/other (hereafter referred to as “internships”) hours must sign this agreement. “Confidential information” means any information of a secret or confidential nature relating to the internship workplace.

Confidential information may include but is not limited to, the following: trade secrets, proprietary information, student information, student lists, methods, plans, documents, data, manuals, notebooks, reports, processes, software, information systems, contracts, strategic planning, proposals, business alliances, and training materials.

In connection with being enrolled in a Wayfinders internship or other, I agree to the following:

I have read and understood the above definition of “confidential information.” I agree that I will not at any time, both during and after my enrollment in Wayfiners internships, communicate or disclose confidential information to any person, corporation, or entity.

I further recognize and agree that while in Wayfinders internships, I may become aware of nonpublic information of a personal nature about employees or students, including, without limitation, actions, omissions, statements, or personally identifiable medical, family, financial, social, behavioral, or other personal or private information. I will not disclose any such information that I learn in a CTVA internship to any other person or entity unless required by applicable law or legal process.

Completion of Internship:

Wayfinders is under no obligation to offer full-time employment to the student prior to or after graduation. Likewise, the student is under no obligation to the employer after completion of the internship. The training period of this internship ends when the intern completes their hours with Wayfinders.

Termination of Internship:

The internship will or may terminate if a) the Parties mutually agree to terminate the internship; and/or b) if the Intern is in breach of the Internship expectations. Wayfinders is under no obligation to keep the intern on as an employee.

Electronic Signature and Submission

I affirm that all information on this application is complete and true. I will adhere to all information in the above agreement.

Intern/Practicum Applicant: Please read the statement above and sign below. *

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