EmailMe Form - STAR Intern Application

STAR Intern Application

STAR's internship program supports the agency mission through graduate and undergraduate internships and offers a collaborative, supportive and creative learning environment with many opportunities for students to work autonomously with the guidance of a supervisor, integrate theory and practice, and develop new projects and initiatives within a non-profit, social service organization. Internships are unpaid.

Please complete and submit this application to be considered as a potential intern candidate.

Name *
First Last
Birthday *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email *
Your preferred method of contact: *
Phone
Email
Text
Requested STAR location for internship site" *
Education & Work Experience
What is your current student status? *
School name: *
School location (city/state): *
Anticipated date of graduation: *
Major/Minor: *
Is this internship part of a school requirement? *
Current (or last) Employer: *
Position:
Dates employed:
Interests and Skills
Why do you want to intern at STAR? *
What internship are you interested in?
First choice *
Second choice
Please upload your resume: *
Availability
Anticipated start date of internship:
MM / DD / YYYY
Anticipated end date of internship:
MM / DD / YYYY
How many hours per week are you available to intern?
Please select the dates and times during your anticipated internship start/end date that you are available to intern.

9:00am - 12:30pm 12:30pm - 5:00pm

Monday

Tuesday

Wednesday

Thursday

Friday
Are you interested in having part of your internship include being on-call for phone and hospital advocacy after hours and/or on weekend? *
References
Please list names, phone numbers, and e-mail addresses of two references (personal or professional):
Name *
First Last
Relation to you: *
Phone *
### - ### - ####
Email *
Name *
First Last
Relation to you: *
Phone *
### - ### - ####
Email *
What language(s) do you speak?
Do you have access to reliable transportation? *
Have you ever been a client at STAR? *
If yes, when?
How did you hear about STAR? *
Have you or someone in your life had a personal experience with sexual or domestic violence? *
Have you ever been charged or convicted of any crime? *
If yes, please explain
NOTE: A background check and fingerprinting is required for all interns who provide direct services to clients.
Demographics (optional):
This information is optional and is being collected for the purpose of maintaining compliance with STAR's Diversity Plan. Please complete the following information as you feel comfortable.
Gender
Race/Ethnicity
Are you a member of the military?
By submitting this application, I hereby apply to intern with the Sexual Trauma Awareness and Response (STAR) and certify that I have made no falsifications, misrepresentations, or omissions in this application. I hereby give STAR permission to contact my listed references.

	9:00am - 12:30pm	12:30pm - 5:00pm
Monday
Tuesday
Wednesday
Thursday
Friday

Education & Work Experience

Interests and Skills

What internship are you interested in?

Availability

References

NOTE: A background check and fingerprinting is required for all interns who provide direct services to clients.

Demographics (optional):