Personal Information

Date:

Name:

Mailing Address:


Phone:

E-mail:

Parent/Guardian Name:

Address:


Phone:

I am applying for an internship during:

Winter
Spring
Summer
Fall

Earliest Date Available to Begin Internship:

Latest Date Available to End Internship:

I would like to participate in the following program:

Washington, DC Office

Legislative
Press

.........................................

State Offices

Seattle
Spokane
Everett
Vancouver
Yakima

For a Washington State office, please select:

Outreach
Casework

College/University in which you're currently enrolled:



School Address:


Dept. Phone:

Major:

Will you receive credit for the internship:

College credit

Activities/Interests:

How did you hear about our internship opportunities?