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Facesheet

Thank you for your interest in the Children's National psychology externships! Please complete the following questions. After you complete this survey, please refer back to the externship advertisement to complete the remaining pieces of your application.

Name:

* must provide value

Email:

* must provide value

Graduate School/Institution Name:

* must provide value

Program name/focus (e.g, Clinical Psychology, Counseling Psychology, School):

* must provide value

Type of Degree:

* must provide value

PhD

PsyD

Other

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In the 2024-2025 training year, what year of your program will you be in:

* must provide value

What externships are you applying to this year? Please check all that apply.

* must provide value

Mood and Anxiety Disorders

Hematology/Oncology

Allergy/Immunology

Anxiety and Eating Disorders

Sleep

Burn and Trauma Surgery

Diabetes

Gastroenterology

Behavioral Headache

Behavioral Pain Medicine

HIV Services

Anxiety and Eating Disorders

Solid Organ Transplant

Early Childhood Behavioral Health

ADHD and Learning Differences

Behavioral Parent Training Clinic

Child Development Program

Pediatric Mood/Trauma

Whole Bear Care, Integrated Primary Care

Inpatient Psychiatry

Selected Pediatric Psychology Subspecialties

Eating Disorders

Gender identity: How do you describe yourself?

* must provide value

Male

Female

Transgender

Another gender

Prefer not to answer

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Gender identity: How do you describe yourself?

Ethnicity

* must provide value

Hispanic or Latino/a/x

Non-Hispanic or Latino/a/x

Prefer not to answer

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Race (select all that apply)

* must provide value

White/European American

Middle Eastern/North African

Native American

Native Hawaiian or Pacific Islander

Black/African American

Asian/Asian American

Another Race

Prefer not to answer

Race: Another.

Do you come from a rural background? (Definition: Rural is a geographical area that is not part of a Metropolitan Statistical Area)

* must provide value

Yes

Prefer not to answer

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Do you come from an economically disadvantaged background? (Definition: Comes from a family with an annual income below low-income thresholds according to family size published by the US Bureau of Census)

* must provide value

Yes

Prefer not to answer

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Do you have a disability?

* must provide value

Yes

Prefer not to answer

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Do you have language proficiency (enough to conduct clinical care) in a language other than English?

* must provide value

Yes

Prefer not to answer

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What other language?

Are you a first generation college student?

* must provide value

Yes

Prefer not to answer

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Is there any other information about your identity, not already asked, that you are comfortable sharing?

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Thank you!

Please refer back to the brochure for instructions to complete your applications.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.