Externship Application

Complete the form below and upload the following application materials:

1. A current vita listing all relevant work experience and practica. 
2. A graduate transcript (unofficial is acceptable). 
3. Two letters of reference, including at least one from a supervisor familiar with your clinical work. Applicants may email letters of reference directly to the externship coordinator if preferred.   

Applications are not considered complete unless materials are submitted via this application portal.

Applications are due at 8am on Friday, January 26, 2024. 

Contact Chrissy Walsh, PhD at cwalsh AT_TOWSON with any questions or concerns.

Full Name:

Preferred Name:

Pronouns:

Email Address:

Current Address (mailing address, including city, state and zip code):

Phone Number:

Highest degree earned at present (MA, MS, etc.):

Has disciplinary action, in writing, of any sort ever been taken against you or is a complaint currently pending against you by a supervisor, educational or training institution, health care institution, professional association, or licensing / certification board?

YesNo

If 'Yes', please elaborate:

Have you ever been put on probation, suspended, terminated, or resigned from a graduate or internship training program, practicum site, or employer, or are you currently on a performance improvement plan (e.g., learning, developmental, remediation plan, etc.)?

YesNo

If 'Yes', please elaborate:

Has there ever been a decision in a civil suit rendered against you relative to your professional work, or is any such action pending?

YesNo

If 'Yes', please elaborate:

Have you ever been convicted of a felony or an offense against the law (other than a minor traffic violation)?

YesNo

If 'Yes', please elaborate:

Please briefly describe the prior experiences (e.g., coursework, practicum experiences, etc.) you have had that you feel have prepared you for being on externship at Towson University Counseling Center.  (No more than 250 words.):

Why do you want to work at our externship site? (No more than 250 words.):

What would be your goals and expectations during externship at the Towson University Counseling Center? (No more than 250 words.):

What strengths do you feel you would contribute during your time on externship? (No more than 250 words.):

Please give a rough estimate of the total number of face-to-face clinical hours you have earned during your training thus far.  Please specify by the following types: intake, individual therapy, group therapy, outreach, and other:

Please give an estimate of the overall total numbers of clients you have seen:

The following upload function is not approved for Personally Identifiable Information (PII) or confidential data. For more information on data classification, visit the Office of Technology Service’s Data Management Page.

Please upload your document:

 

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