Name
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First Name
Last Name
Email
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Phone
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Current City and State of residence
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How did you hear about this internship position with Colorado Therapy Collective? (E.g. Google search, Masters program, colleague, Indeed, Linkedin, etc)
Are you currently enrolled in a Masters or Doctorate Degree in Marriage and Family Therapy, Counseling, Psychology, or Social Work from an accredited university?
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Name of your current university and Masters or Doctorate program
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Have you completed an ICEEFT-approved Emotionally-Focused Therapy Externship?
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If you have not completed an EFT Externship, what is your familiarity and/or interest in training in and working with Emotionally Focused Therapy (EFT)?
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The internship training program at Colorado Therapyy Collective requires a 12-month commitment. Are you interested in and willing to commit to a 12-month internship?
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What are the dates and semesters that you are seeking internship?
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What are the clinical hours and supervision requirements from your Masters program for your Internship? Please specify whether you are required to have group therapy hours?
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Please list any trainings or certifications you have completed in other therapy modalities/specialties (examples EMDR, DBT, Sex Therapy, etc.)
Please tell us briefly about your areas of interest, previous work experience, and any other information that informs us about your ability to work with individuals, couples, and/or families
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What is your comfort level working with couples? How would you feel about that caseload full time?
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Please describe how you would approach couples from an attachment perspective. Please also describe your understanding of what would NOT be an attachment approach to couple distress and challenges.
Do you have availability and willingness to work at least 18 hours/week over 3-5 days per week, including at least 2 evenings until 8pm?*
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Ideally, how many client hours would you like per week?
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Why do you want to intern in a group practice? What interests you about Colorado Therapy Collective specifically?
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Please tell us briefly about yourself. How would your colleagues and/or clients describe you?
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Would you consider yourself LGBTQIA+ affirmative? If so, what does that mean to you?
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Please describe your experience working with racially and culturally diverse clients
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Do you feel comfortable and competent working independently and managing client cases including scheduling, taking client payments, keeping accurate and timely notes, responding in a professional and timely manner, and staying organized?
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Please provide 3 professional references, their contact information and relationship to you. (We will notify you before we contact any references.)
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Has any claim or suit ever been brought against you for alleged malpractice or professional liability, or are you aware of any incident or existing circumstances that might reasonably lead to a claim or suit?
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Have you ever been refused coverage for professional liability or malpractice insurance or has your malpractice or professional liability insurance ever been canceled or declined for renewal (non-renewed)?
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Have you ever been convicted of a misdemeanor or felony?
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Have any complaints ever been filed against you or have there ever been any formal or informal investigations or inquiries opened with a peer review committee or an ethics committee of a professional association, hospital, health care facility, or any other governmental or private entity?
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Have you ever been vicariously or directly accused of sexual misconduct or any professional impropriety?
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Do you know of any reason why you cannot comply with the legal, ethical, or professional standards set by law, by regulation, by a peer review committee or by an applicable code of ethics in any jurisdiction where you provide services?
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If you answered 'Yes' to any of the above questions, please provide additional information below
Anything else you'd like us to know?
