School Counselor Internship Application
Santa Clara County Office of Education
Alternative Education Department
Personal Information
Last Name
First Name
Street Address
Home Number
City
Cell Phone Number
State
Zip Code
Email Address
Availability
Monday
Tuesday
Wednesday
Thursday
Educational Background
High School
Location
Degree
College
Location
Degree
Graduate School
Location
Degree
Previous Employment
Company
Address
Job Title
From:
Reason For Leaving:
Supervisor's Name
Address
Job Title
Reason For Leaving:
Supervisor's Name
Address
Job Title
Reason For Leaving:
Supervisor's Name
To:
Company
From:
To:
Company
From:
To:
Friday
1. What has prepared you for an internship with the Alternative Education Department and our
underserved students?
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2. How do you bring “hope” to a person who feels they have run out of options and chances?
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3. What attribute, trait, or skill would you bring to the school site?
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4. What grade level of students would you prefer to work with?
Middle school ______
High School ______
Community School ______
Court School _____
5. Any additional information you would like to add?
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