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Questionnaire

First and Last Name

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Email Address

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Phone Number

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Which therapy discipline are you interested in? Please select all that apply.

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Which of the following topics are you interested in? Please select all that apply.

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Are you currently in college?

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Which college do you attend?

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What is your major?

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How did you hear about Little Light House?

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Why do you want to be a therapy intern at Little Light House?

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Are their any dates over the summer that you would be unable to attend your LLH Internship?

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Do you need an internship or volunteer hours for college credit?

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If yes, how many hours and is there associated paperwork you need from LLH?

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