Peer Internship Program Application--Cohort 10 (FY-24-25)

Peer Counseling Internship Program Application Form

Division of Peer Based Services
The RAMS Peer Counseling Internship is a 9-month, up-to-20 hours/week, hands-on training program for individuals (or their family members) who have accessed mental health and/or substance use services in the past or present, and who are interested in pursuing Peer Counseling as a career path. The program pays each intern a stipend of $20.25/hour.

Interns will be asked to present RAMS with proof of Covid vaccinations and one booster shot. Medical exemptions are potentially possible per RAMS policies.

Important dates:
- Peer Internship Open House: Monday, July 1st, 2024 12pm-1pm
  - Zoom Link: Peer Internship Info Session
- Application Deadline: Monday, July 22nd, 2024 by 5pm
- Notification of Application Status: By Wednesday, July 31st, 2024
- Internship begins Wednesday, Aug. 21st, 2024
- Internship graduation: End of May, 2025
If you have any questions or need additional information, please reach out to Lara Ezrin at peerinternship@ramsinc.org.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
How did you hear about this Internship?
Have you or a family member (currently or in the past) had personal experience with community behavioral health services in San Francisco (such as accessed mental health services, substance use services, enrolled in vocational training program, or a similar service from a San Francisco community agency)?
Other than English, please list all the languages you speak well enough to potentially provide services in. Please separate each language using commas.
Check the box that reflects your highest level of education completion

High School diploma / GED High School EquivalencyAssociate DegreeBachelor's DegreeMaster's Degree
Please list two professional or personal references (example: professional - last employer, former teacher, etc.; personal reference - neighbor, friend, roommate, etc Please inform your references that we may be contacting them.
Reference 1: Name
Reference 1: How do you know them?
Reference 1: Contact Information (email and/or phone #)
Reference 2: Name
Reference 2: How do you know them?
Reference 2: Contact Information (email and/or phone #)
DEMOGRAPHIC INFORMATION (optional)
This information is for data collection purposes only. The Peer Internship Program respects your privacy and we are bound by the confidentiality rules and regulations that apply.
Race/Ethnic Background (check all that apply)

White/CaucasianAfrican American/BlackHispanic, Latino/a, or Spanish OriginNative American or Alaska NativeAsian IndianFilipinoChineseJapaneseKoreanVietnameseOther Asian (e.g. Hmong, Thai, Pakistani, Cambodian, etc.)Native HawaiianGuamanian or ChamorroSamoanPacific Islander (e.g. Fijian, Tongan, etc.)Middle EasternOther
If you selected Other, please specify: Please type here
If you selected Hispanic, Latino/a or Spanish Origin, please specify:Please type here
If you selected Other Asian, please specify: Please type here
If you selected Other Pacific Islander, please specify: Please type here
If you selected Middle Eastern, please specify: Please type here
Sexual Orientation

Heterosexual: Opposite SexLesbian: Female/FemaleGay: Male/MaleBisexual: Both Male & FemaleUnsureOther
If you selected Other, please specify:Please type here
Gender

MaleFemaleTrans (Female)Trans (Male)Other
If you selected Other, please specify:Please type here
Age

18yr.-25yr.26yr.-59yr.60+ yr.
Primary Language
Other Languages/Dialects Spoken
Country of Birth
Year of Entry into the U.S
Please attach resume AND proof of San Francisco Residency with the application (e.g. Driver's License or CA State)

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Attach a copy of your most recent diploma or transcript (official or unofficial transcripts) If you have any questions, please contact us by phone at 415-307-6805 or by email peerinternship@ramsinc.org.

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** Please upload a personal statement to the application below**

In your personal statement, please tell us about each of the following (up to four pages typed or eight pages handwritten):
- About yourself
- Reasons why you want to become a Peer Intern
- How you hope to utilize the skills you learn to contribute to the counseling field.
- In order to be able to support others in their recovery, it is important for the peer provider to be actively engaged in her/his own recovery. Please describe what wellness & recovery mean to you.
- It takes a lot of commitment to complete this internship; what challenges might you anticipate for yourself, and how could you manage them?
Please upload your personal statement here

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Please read and initial each paragraph, then sign below.
I certify that I have not purposely withheld any information that might negatively affect my chances for acceptance. The answers given by me are true & correct to the best of my knowledge and ability. Initial Here
I permit the Peer Internship Program to contact the references I provided. I authorize the references I have listed to provide any information about my related experiences, without giving me prior notice of such disclosure.Initial Here
Applicant's Signature

Clear
Date

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Peer Counseling Internship Program Application Form