APPENDIX H:

APPENDIX H:

INTERNSHIP APPLICATION

OVERVIEW:

The Ship Group Community Services offers intern opportunities to individuals pursuing education in behavioral healthcare and counseling.

We offer a vast array of outpatient child and adult behavioral health services including Targeted Case Management, Intensive In-Home, Child/Adolescent Day Treatment, Community Support Team, Assertive Community Treatment Team, Outpatient Therapy, Medication Management, and Diagnostic Assessments. For the intern we will provide training, mentoring and supervision in the clinical practice of behavioral health.

▪ The training provided to the intern is similar to that given in a vocational or academic educational 

instruction.

▪ The training provided to the intern is for his or her benefit.

▪ The intern does not displace regular employees, but works under their close observation or 

supervision.

▪ The Ship Group Community Services receives no immediate advantage from the intern’s 

activities.

▪ The intern is not guaranteed a position at the conclusion of the internship.

▪ The intern understands the internship will be unpaid.

The student agrees to do the following:

▪ Obtain and keep liability insurance during the course of the internship

▪ Report to the specified work area on time as scheduled

▪ Communicate effectively, both verbally and in writing

▪ Conduct him/herself in a professional manner at all times

▪ Maintain the highest level of confidentiality regarding, but not limited to, The Ship Group Community Services Care operations/proprietary information, trade secrets, and client 

protected health information.

▪ Contribute to a “zero negativity” environment

▪ Be accountable 

▪ Actively seek learning opportunities within the appropriate student scope and under the 

appropriate clinical supervision

▪ Establish professional boundaries and therapeutic relationships with both clients and The Ship 

Group Community Services Care staff

▪ Seek clarification when in doubt

▪ Complete assignments including clinical documentation within the allotted time frame

▪ Reference and follow The Ship Group Community Services Care Policies and Procedures as 

appropriate

---The Ship Group Community Services Intern Application---

Dear ___________________:

We are pleased to offer you an internship with The Ship Group Community Services , LLC.

As we discussed, your internship is expected to last from __________ to __________, for _______ hours per 

week. However, at the sole discretion of the company, the duration of the internship may be extended or 

shortened with or without advance notice.

As an intern, you will not be a company employee. Therefore, you will not receive a salary, wages, or other 

compensation. In addition, you will not be eligible for any benefits that the company offers its employees, 

including, but not limited to, health, dental, and vision benefits, PTO, or 401k. You understand that participation 

in the internship program is not an offer of employment, and successful completion of the internship does not 

entitle you to employment with The Ship Group Community Services 

During your internship, you may have access to confidential, proprietary, and/or trade secret information belonging 

to the company. You agree that you will keep all of this information strictly confidential and refrain from using it 

for your own purposes or from disclosing it to anyone outside of the company. In addition, you agree that, upon 

conclusion of the internship, you will immediately return to the company all of its property, equipment, and 

documents, including electronically stored information.

By accepting this offer, you agree that you will follow all of The Ship Group Community Services Care’s policies 

that apply to non-employee interns, including, for example, the company’s anti-harassment policy.

The letter constitutes the complete understanding between you and The Ship Group Community Services 

regarding your internship and supersedes all prior discussions or agreements. This letter may only be modified 

with a written agreement signed by Human Resources and the intern. Please indicate your acceptance of this 

offer by signing below and returning it to the HR Department.

We are pleased to extend this internship offer to you, and hope that your internship will be rewarding. If you have 

any questions please feel free to contact the HR Department at 

Sincerely,

I accept the internship offered by The Ship Group Community Services on the terms and conditions described in 

this letter.

_______________________________________ Printed Name

THE SHIP GROUP COMMUNITY SERVICE LLC.

Policies & Procedures Manual

_______________________________________ Signature

_______________________________________ Date

Last Name First Date

INTERNSHIP CHECKLIST:

Within Week 1 of Internship, the following OVERVIEWS will have been completed.

TOPIC DATE OF COMPLETION FACILITATOR 

INITIALS

 Understanding the The Ship Group Community 

Services Care Way

 Client Rights/HIPAA/Confidentiality

 Workplace Safety

 Documentation

THE SHIP GROUP COMMUNITY SERVICES CARE ASSIGNED CLINICAL MENTOR: 

______________________________________________

*SECONDARY CLINICAL MENTOR: ____________________________________________________________

Start Date: Anticipated Completion Date: Frequency/Duration:

Name of Supervising Faculty: Phone / Email:

LEARNING PLAN (To be reviewed by the Training Director and Clinical Director):

Objective 1:

 Met

 Not Met

Objective 2:

 Met

 Not Met

Objective 3:

 Met

 Not Met

Objective 4:

 Met

 Not Met

Objective 5:

 Met

 Not Met

Objective 6:

 Met

 Not Met

THE SHIP GROUP COMMUNITY SERVICE LLC.

Policies & Procedures Manual

Action: 

ACTIVA

TE Crisis 

Respons

e System

Client/Famil

y

Action: 

Level 1 

Respon

se

Paraprofessio

nal

Action: 

Level 2 

Respon

se

Associate 

Professiona

l

Action: 

Level 3 

Respon

se

Qualified 

Professiona

l

Action: 

Level 3 

Respon

se

1st 

Responder 

(QP)

Record pertinent crisis 

information (caller, 

location, callback #, 

nature of crisis).

Assess for immediate risks to life 

(suicide threat, psychosis, homicide 

threat) and report to QP 

immediately.

If no immediate 

psychosis, 

suicidal/homicidal 

threat, document and 

report to QP on 

team/team leader/1st 

Responder within 15 

minutes of the call.

Student Signature: ___________________________________________________________________________

Clinical Mentor Signature: _____________________________________________________________________

Training Director and Clinical Director Signatures: __________________________________________________