Internship Application Internship Application Δ Step 1 of 3 33% LinkedInThis field is for validation purposes and should be left unchanged.Personal InformationName* First Last Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone #*Email Address* College/University*Degree or credential you are seeking (i.e. Bachelors Degree in Psychology)*Anticipated Graduation Date* Internship InformationCollege/University Supervisor Name, Phone Number & Email:*Please check semester(s) of interest:* Select All Fall Spring Summer Anticipated Start & End Dates*Total Hours Needed*Days or Evenings? (Weekend hours are not available at this time. Also, our Bensalem facility does not have evening hours available for clinical department interns.*Hours Per Week?*Please select all Livengrin locations where you would be open to completing your internship.* Medical Department (Bensalem ONLY) Inpatient: Bensalem Outpatient: Bensalem Outpatient: Lehigh Valley Outpatient: Fairless Hills Upload your Resume*Accepted file types: doc, pdf, Max. file size: 2 GB. I certify that all of my answers are true and complete to the best of my knowledge. If this application leads to an internship assignment, I understand that false or misleading information in my application may result in my release. Livengrin: Building Recovery Together Gifting & Donations Events
