Request for Psychiatry and Behavioral Health Clinical Counseling
Name
Phone Number
Email
College/University
Program of Study
Penn State Health Entity Location
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Any Penn State Health Location
Specific Location
If specific location, which location?
Number of Hours Requested
Is this required for:
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School Program
Personal Interest
Requested Start Dates
Requested End Dates
Requests are reviewed based on department availability and prioritization. Requests must be submitted at least three months prior to the requested start date.
Contact Information