Internship Application Contact Information The * means the field is required Your Full Name * Pronouns?* Date of Birth* Your Email* Home Address* If you have a cell phone, what is your number? If you have a work number, what is it? What is your home number? Do you have another phone number you wish us to know? Which number is best for us to reach you on*? CellWorkHomeOther Educational Institution Information All information here is required for an internship application. What education institute are you attending? What is the focus of your degree? When is your graduation date? Internship Course: When does your internship course begin? When does your internship course end? Which department? What is your educational institution's mailing address? What is your professor/teacher's name? What is their phone number? What is their email address? Internship Information Internship start date: Internship end date: Number of hours per week: Total number of hours: If your internship requires your supervisor to have a certain certification or degree, tell us which one: Learning about you How did you hear about Women Helping Women's Internship Program? Why are you interested in an internship at Women Helping Women? Please list any special skills or training you have: If you have prior volunteer/internship experience, tell us where and when: If you have prior experience or training in COUNSELING, please tell us about where and when: If you have prior experience or training in CRISIS INTERVENTION, please tell us about where and when: If you have prior experience or training in PUBLIC SPEAKING, please tell us about where and when: If you have prior experience or training in ADMIN/CLERICAL, please tell us about where and when: If you have prior experience or training in FUNDRAISING, please tell us about where and when: Do you have a valid driver's license? —Please choose an option—YesNo All interns at Women Helping Women must submit to a criminal background check. Have you ever been convicted of a crime? —Please choose an option—YesNo If you answered yes, please explain: Internship Locations and Opportunities Which county are you applying for? (Required) —Please choose an option—Butler CountyHamilton CountyBoth Please select all the opportunities you are interested in for Butler County: Hospital AccompanimentSpecial EventsSchool and Community Education Please select all the opportunities you are interested in for Hamilton County: Hospital AccompanimentCourt Advocate (Weekday)Court Advocate (Saturday)Court Advocate (Sunday)Hotline Advocate (Weekday)Special EventsSchool and Community EducationDevelopment/AdministrativeUnsure Personal and Professional References Please give us the name, phone number, and email address of your first reference: Please give us the name, phone number, and email address of your second reference: Please give us the name, phone number, and email address of your third reference:
