Centennial Peaks Hospital Internship Inquiry Form

Centennial Peaks Hospital supports professional education by providing the opportunity for a limited number of students from accredited, professional mental health, medical, occupational/ recreation therapy and nursing programs to obtain clinical experience.  If you would like to inquire about completing an internship at Centennial Peaks, please submit the information below.

Please note:  Due to a high volume of requests we will not be able to respond to every request personally.

Name: 

Address:

Phone Number    School:

Degree Program:

If not in school, are you working towards CAC (Certified Addictions Counselor) certification?             yes no

Desired Start Date:   Length Internship Desired:  

Will you require supervision by a Centennial Peaks Hospital Staff member? yes no

If yes, what credentials are required of the CPH supervisor?

How many hours of supervision are required during the internship?

Does your school have an outline of internship expectations, goals, and objectives? yes no

Is there anything else you would like to tell us about yourself? (Prior experience, skills, etc.)

** In accordance with state licensure and certification requirements, interns will be subject to a criminal background check and a central registry check prior to beginning placement.

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