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About
About
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Contact
Board of Directors
News
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Services
Training Center
Policy and Advocacy
Workforce
Finance and Operations
Clinical Services
Emergency Management
Health IT & Cybersecurity
Pharmacy
Training & Events
Training & Events
National Health Center Week
Annual Health Care Symposium
Health IT Summit
Policy Café
Membership
Membership
Join
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Integrated Behavioral Health Pipeline Program – Applicant Application
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Integrated Behavioral Health Pipeline Program
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Integrated Behavioral Health Pipeline Program – Applicant Application
Step
1
of
3
33%
Program Eligibility
Are you currently an MSW student?
(Required)
Yes
No
Are you going to be in your 2nd year of your MSW program this Fall?
(Required)
Yes
No
Contact Information
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Demographic Questions
How do you identify your gender?
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
What is your ethnic background?
(Required)
Education & Availibility
Where are you completing your MSW program?
(Required)
What date does your second-year fall semester begin?
(Required)
MM slash DD slash YYYY
What days do you usually have class?
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What days do you plan on completing your internship?
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What days of the week would you prefer group didactic sessions to occur?
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Is there anything we should know about your availability?
(Required)
Internship Placement
Have you applied to a community health center for placement?
(Required)
Yes
No
Which community health center(s) have you applied to?
(Required)
To be eligible for the program, you will need to be placed at one of our member health centers. Visit: https://ccalac.org/member-clinics/ to view which health centers are part of our association.
Have you been interviewed by the health centers already?
(Required)
Yes
No
Personal Insight Questions
Why are you interested in community health?
(Required)
How would this program support your career development?
(Required)
Thank you for your interest! Based on your responses to the first two questions, you are not eligible for the program.
Please contact the Workforce team at recruitment@ccalac.org if you have any questions or concerns. Thanks!
Application Completion
(Required)
By checking this box, you acknowledge all of the program requirements and understand the program commitments.
Signature
(Required)
