Application for Child Life Internship

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Date:
Name:
University:
Year In School:
Anticipation Graduation Date:
Major:
Minor:
When do you plan to participate in an internship:
How many weeks are in your semester:
From:	To:
When are your scheduled University breaks and/or holidays:
Do you wish to work through your breaks and/or holidays:
University Supervisor:
Address:
Telephone:
Fax:
E-Mail:
Best time to Contact:
Applicant's University (or present) address:
Home address:
University phone number:
University e-mail:
Home phone number:
Home e-mail:
In Case of Emergency, notify:
Name:
Address:
Telephone:
Relationship:
Optional Information:
Sex:
Marital Status:
Nationality:
Name of Spouse:
Spouse's Occupation:
With this application, please include the following: At least two letters of references on official letterhead, including 100 documented hours working with both healthy and ill children one from a professor in your major field of study one from someone, unrelated to you, who is well acquainted with you and your work with children Additional documentation on official letterhead may be necessary if reference letters do not include the required documented hours One official university transcript (your university may forward the transcript to us) Resume may be included if applicable Typed answers to the listed questions Questions - Please type. What is your career objective? What do you know about Riley Hospital? Why did you choose Riley Hospital for your internship? How would you describe the role of a Child Life Specialist? What experiences have you had in working with both healthy AND ill or special needs children? What strengths would you bring to this internship? In what areas do you feel you need the most help? What are your goals for your internship? I understand that if accepted, I must attend all required Clarian Health orientations and complete the Volunteer Services health screen. I have read the attached Internship Packet and understand the requirements. I have included all of the application information. Student's Signature______________________ Date________________________

Contacting Riley Hospital Child Life Programs

For more information, to submit an internship application, or for questions related to student opportunities at Riley Hospital for Children, contact:

Riley Hospital for Children
Child Life Programs
Attn: Student Coordinators
702 Barnhill Drive, Room 1960
Indianapolis, IN 46202-5200
(317) 274-1127
childliferiley@clarian.org

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Application for Child Life Internship

In Case of Emergency, notify:

Optional Information:

With this application, please include the following:

Contacting Riley Hospital Child Life Programs