Internship Application

Name

First

Last

Address: Street/City/State/Zip

Phone Number

Email

Internship Placement

Please provide your area of study, university affiliation, supervisor name and # of hours required.

Availability

Availability Notes?

Area of Specialization

Administrative: Program Director
Administrative: Marketing/Public Relations
Programming (Youth)

Age Group Preference

Tell us which age group you would prefer to work with, we will try and place you with this preference as much as possible.

Site Preference

E Fayette Street Club
Shonnard Street Club
Central Village

Tell us which site you would prefer to work at, we will try and place you with this preference as much as possible

Summarize special skills and qualifications you have acquired from course work, practicum experiences, employment, previous volunteer work, or through other activities, including hobbies or sports.

Major Area of Concentration – Tell us about your major and how you would utilize this area into your internship with the Boys & Girls Club.

What is your experience and knowledge about the Boys & Girls Clubs of Syracuse?

Reference #1

First

Last

Reference #1 Phone Number

Reference #2

First

Last

Reference #2 Phone Number

Emergency Contact

First

Last

Emergency Contact Relationship

Emergency Contact Phone Number

Statement of Agreement – by submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

I agree
I do not agree