Internship Application Form

Apply for a Foxx Office Internship!

Salutation:*

Select OneMr.Mrs.Ms.Dr.Rev.Prof.Maj.Col.Fr.

First Name:*

Middle Initial:

Last Name:*

Date Of Birth:*

Gender:

Select OneMaleFemale

Home Phone:*

Fax Number:

Work Phone:

Mobile Phone:*

E-mail Address:*

Address:*

Address 2:

City:*

County:

State:*

Select OneAKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Zip Code(5-Digit):*

Zip Code(4-Digit):

Mailing Address:*

Address 2:

City:*

State:*

Select OneAKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Zip Code(5-Digit):*

Zip Code(4-Digit):

Indicate where you would like to have your internship: *

Washington, D.C.

Clemmons, N.C.

Boone, N.C.

Age: *

Permanent Home Address (if different from above):

Name of High School and GPA:

Name of College/University and GPA:

Major(s)/Minor(s):

Year in School:

Will you receive credit for this internship?

Yes

No

Dates AVAILABLE for internship: *

Please list below your computer skills:

List three persons, historical or current, that you most admire:

On a scale of 1 (most liberal) - 10 (most conservative), how would you describe yourself? *

List the names of any organizations to which you belong and the positions you currently hold:

Describe any jobs you have held and how these experiences have prepared you to work in Congresswoman Foxx's office:

Explain why you want to be an intern for Congresswoman Foxx and what you hope to get out of your time with us:

Please list three references and include name, phone number, and relation to you: