| Name: | ________________________________________________ |
| Home Address: | _____________________________________________________________ _____________________________________________________________ |
| School Address: | _____________________________________________________________ _____________________________________________________________ |
| E-Mail Address: | __________________________________________________________ |
| Telephone Numbers: |
Home ___________________________ School ____________________________ Cell _____________________________ |
| Date of Birth: | ____________________________________ |
| Social Security #: | ____________________________________ |
| Are you a U.S. citizen? | Yes________ No _________ |
| Parent's Names and Address: | ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ |
| Parent's Phone: | ________________________________________________ |
| School Name: | ____________________________________________________________ |
| College Major: | ____________________________________________________________ |
| Grade Point Avg: | _______________________ |
| Last Year Completed (circle one): | Freshman Sophomore Junior Senior |
| Your internship choice: |
______ Fall Session: September 5th - December 15th ______ Spring Session: January 3rd - May 18th ______ Summer Session I: May 21st - June 22nd ______ Summer Session II: June 25th - August 3rd ______ No preference ______ Other |
| Last day of school for semester prior to internship choice: ________________________________ | |
| First day of school for semester following internship choice: ______________________________ | |
Remember to include your cover letter, resume, two letters of recommendation, and complete grade transcript. Your packet must be complete in order to be considered for Senator Hutchison's Internship Program. Thank you for your interest.