intern with mental health america

Thank you for your interest in interning at MHA. Please complete the application below. 

Is your current address the same as your permanent address?
YesNo

Date of Birth

Sex
MaleFemaleNon-Binary


Work and Volunteer Experiences
Please list your most recent work and volunteer experiences

Start Date

Start Date

Start Date


Education

Start Date

End Date

I would like to have the Crisis Center be a part of my internship experience



Criminal History

Have you ever been arrested?
YesNo

Have you ever been convicted of a crime?
YesNo

Do you give us permission to check this information?
YesNo



Personal Information

Program Interests
Why are you interested in an internship with MHA?

What experiences, hobbies, skills do you have which might help MHA?

Are there any other obligations you will have during the course of your internship?

Please list your community interest or groups with whom you are affiliated



References

Please list three local references who we may contact.

Reference #1

Reference #2

Reference #3

I authorize Mental Health America to contact my references that I have provided above, and to inquire about my internship candidacy. The above-named persons are aware that Mental Health America will contact them and MHA has my permission to discuss any relevant information.



Emergency Contact



Verification

By signing my full name, I hereby certify that the information on this application is accurate and complete to the best of my knowledge.