Internship Application Form

NAME________________________________________________________________________

HOME ADDRESS_____________________________________________________________

CITY, STATE, ZIP CODE________________________________________________________

HOME PHONE_________________

SOCIAL SECURITY NUMBER___________________

NAME OF COLLEGE___________________________________________________________

SCHOOL ADDRESS____________________________________________________________

CITY, STATE, ZIP CODE________________________________________________________
SCHOOL PHONE_____________________

E-MAIL ADDRESS_______________________

EXPECTED GRADUATION DATE__________ GRADE POINT AVERAGE__________

INTERNSHIP DESIRED: FALL________ SPRING________ SUMMER________

PLEASE LIST ISSUES AND/OR AREAS OF PUBLIC POLICY THAT ARE OF PARTICULAR INTEREST TO YOU:





ON A SEPARATE PAGE, PLEASE WRITE A SHORT STATEMENT ELUCIDATING WHAT YOU HOPE TO LEARN THROUGH AN INTERNSHIP EXPERIENCE ON CAPITOL HILL.

SIGNATURE_________________________________

DATE______________________

Please return the completed application form, one letter of reference, and your resume to DuBose Williamson at: Congressman Rick Boucher 2187 Rayburn House Office Building Washington, D.C. 20515 fax: 202-225-0442