Clinical Counselling Internship Agency Application

This form is for counselling agencies only.

Please fill out the application below to submit a Counselling Intern position for Tyndale students. Please also complete the Clinical Supervisor Criteria Verification Form. For all other inquiries, please email the Counselling Internship Program Coordinator, mlaxamana [at] tyndale [dot] ca (subject: Clinical%20Counselling%20Internship%20Agency%20Application) (Michelle Laxamana) or contact by phone at 416.226.6620 ext 2139.

Agency Information

Name of Agency *

Street Address *

City *

Province *

Postal Code *

Phone Number *

Fax Number

Administrative Contact Person (if different from Supervisor)

Supervisor Information

Supervisor's Name

Supervisor's Email

Supervisor's Phone Number

Supervisor's professional qualification / designation

Internship Program Information

General Description of Agency (including types of counselling offered)

Qualifications necessary for interns to be accepted into the program

Typical Start Date and End Date of Internship

(ie. January - May)

Days / Hours that Interns must be available

Any specialized training programs, in service training, etc. available to students

Any fees charged to interns

Does the site have any religious or philosophical framework? If so, please describe

Any other information that the Interns should know about the site

Leave this field blank