Catawba Hospital
Catawba, Virginia
Therapeutic Recreation Internship Application Form

Name  ____________________________________________________

Home Address ______________________________________________

School Address______________________________________________

School Phone Number ____________Email (optional)_______________

Advisor ______________________     Phone______________________

Name of College/University____________________________________


Desired Beginning and Ending Internship Dates  ______through ______

1.     In what ways would you be an asset to Catawba Hospital during your Internship?


    2.   What is your philosophy of Therapeutic Recreation?


3.     What do you hope to gain from your internship experience?  Explain.


4.     Please list all of your pre-internship clinical experience.  Please list site names, types of facilities, dates, client populations served, responsibilities and unique experiences at each site.


Please send this completed application, three letters of recommendation including one from your internship advisor, and a copy of your official college transcript to:

Autumn M. Hiduskey, CTRS          Brenda Kaye S. Cress, CTRS
Adjunctive Therapy Department     Adjunctive Therapy Department
Catawba Hospital                            Catawba Hospital
PO Box 200                                     PO Box 200
Catawba, Virginia 24070                 Catawba, Virginia 24070
(540) 375-4303 or 375-4347            (540) 375-4303 or 375-4347