Registration form for online internship program

Internship Registration

Full Name:(Required)

Prefix First Last

Phone Number:(Required)

Email:(Required)

Date of Birth:(Required)

City:(Required)

Educational Details:(Required)

Add an attested copy of your Last Degree:(Required)

Max. file size: 10 MB.

Name of University/College:(Required)

Preferred Batch:(Required)

Child and Adolescent Mental health

Adult Mental health

Observership

Why are you interested in Child & Adolescent Mental Health?(Required)

Why are you interested in Adult Mental Health?(Required)

Preferred Training:(Required)

Partially Supervised

Fully Supervised

Preferred Duration:(Required)

Other(Required)

Previous Internship/Training in Psychology?(Required)

If Yes, specify(Required)

Do you have access to laptop & stable internet?(Required)

Yes