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OPEN 7 DAYS A WEEK 9AM-9PM
1-800-913-9613
Specializing in Couples and Sex Therapy
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Houston Relationship Therapy- Dr. Viviana Coles & Associates
Couples Therapy, Sex Therapy, Premarital Counseling
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Our Team
Services
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Request an Appointment
FAQs
Blog
Internship/Job Application
INTERNSHIP/JOB APPLICATION
APPLICANT NAME
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Birthdate and Age:
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Email Address:
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Which BEST describes you?:
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I am a college student
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I am a licensed professional
Phone number:
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Please decribe the position for which you are applying:
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List any Professional Certifications or Licenses you hold (Type "None" if applicable):
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Please tell us about yourself, including your professional pursuits, other languages spoken (if proficient in counseling in that language), and your theoretical orientation:
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Please upload a current photo of yourself:
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Max. file size: 100 MB.
Please upload your current Resume or Curriculum Vita:
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Max. file size: 100 MB.
Have you ever had a complaint filed against you?
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Do you have current Professional Liability Insurance?
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Which languages do you speak fluently?
When is your proposed start date? And end date (for practicum students)?
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PLEASE TYPE YOUR NAME TO ATTEST THAT YOU HAVE PROVIDED ALL TRUTHFUL INFORMATION IN THIS APPLICATION.
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