Sunnyvale Center - Request to Extend Practicum or Internship (4th quarter or beyond)

Sunnyvale Center - Request to Extend Practicum or Internship (4th quarter or beyond)

Request to Extend Practicum or Internship (4th quarter or beyond) Form Preview
Sunnyvale Center - Request to Extend Practicum or Internship (4th quarter or beyond)
  • Request to Extend Practicum or Internship - Sunnyvale Center

    (4th Quarter or Beyond)
  • Submit no later than 4pm on the Monday of week 6 of the quarter.

  • Please download the form below and collect all signatures. Once you have received all signatures, please scan and upload the document to this form.

    Click Here to Download Practicum/Internship Signature Form

  •  -  - Pick a Date
  •  -  - Pick a Date
  •  -  - Pick a Date
  • I, the Student or Intern, acknowledge that I have met with my clinical supervisor and/or clinical director/authorized representative to discuss my request to remain at the Center for an additional period of time. I understand that approval to stay on at the Center is not automatically provided, and is contingent on satisfactory performance in the practicum or internship at the time of this application, supervisor availability, space and client availability. By signing this document, I am agreeing that I will meet all practicum or internship requirements of the Center if I am permitted to extend my time at the Center.

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