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Internship Application
(Please fax to 202-225-9571)
Full Name: _______________________________________________________________________
Social Security:
_________/_____/__________
Permanent Home Address:
Street:
__________________________________________________________________________
City:
_____________________________________ State: _______ Zip Code:
_______________
Home Phone:
(____)___________________
Present School, Mailing and E-mail Address:
Name:
____________________________________________________________________
Address:
__________________________________________________________________
School Phone:
(_____)_____________________ E-mail Address:
_____________________
Status: ___ Freshman, ___
Sophomore, ___ Junior, ___ Senior
MAJOR:
____________________________ MINOR:
__________________________
Expected Date of Graduation:
___________________
Number of course credits you anticipate:
__________
Semester you are interested in
working: __ Summer (May-August),
__ Spring (Jan.-April), __
Fall (Sept.-Dec.)
Starting Date:
__________________ Ending Date: __________________
Name and Phone of Program Coordinator:
____________________________________________ |
