2009 Summer Volunteer Application

2009 Summer Volunteer Application

Internship Application

Full Name Date

Date Available Date of Birth Age Gender


City State Zip

Email Cell Phone Home Phone

School Major

GPA Career Goals

For which internship are you applying (please check appropriate box)?


Marketing & communications,

Development & fundraising, or

Technology & data management?

Describe yourcomputer skills.

Have you ever been arrested or charged with a crime, other than a minor traffic offense?


Yes. If yes, please describe specifically.

Attach a copy of your resume.

Attach a sample of your written work (paper for school, professional report, etc.).


List threeprofessionalor personal references and phone numbersat which FOCUS can easily reach them:

1. NamePhone Relationship

2. NamePhone Relationship

3.Name Phone Relationship


1. Company Job Title

Dates of EmploymentResponsibilities

Supervisor Phone May we contact them? Yes No

2. Company Job Title

Dates of Employment Responsibilities

Supervisor Phone May we contact them? Yes No

3. Company Job Title

Dates of Employment Responsibilities

Supervisor Phone May we contact them? Yes No


List medical conditions & medications

List allergies with treatment:

List injuries in the past 24 months:

In an emergency, please contact (Name): Phone Relationship

Hospital preference:

Doctor’s Name: Phone

If you are applying as a program intern, please answer these five questions:

  1. Please describe your experiences with children, particularly those with disabilities.
  2. First Aid/CPR Certified? No Yes (If Yes, please attach copy of certification.)
  3. Can you easily lift 40 pounds? Yes No (If not, please explain)
  4. Tell us about your hobbies (cooking, music, art, etc.)
  1. Adult T-shirt Size: Small Medium Large XL XXL


I certify that my answers are true and complete to the best of my knowledge. If this application leads to my selection for a FOCUS internship, I understand that false or misleading information in my application or interview may result in my release.

In connection with my voluntary involvement in activities undertaken, and with the participation and support of FOCUS (Families Of Children Under Stress, Inc.), a nonprofit charitable organization, I hereby agree, for myself, my heirs, assigns, executors, and administrators to release and discharge FOCUS, its officers and directors, employees, agents and volunteers from all claims, demands and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from the negligence of FOCUS or anyone working on behalf of FOCUS, and I agree to release and hold FOCUS, its officers and directors, employees, agents and volunteers harmless from any cause or action, claim, or suit arising therewith. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release. Furthermore, I grant permission for photographs, video, and quotations from me during my involvement with FOCUS to be used to promote FOCUS. I hereby confirm, represent and warrant that I have never been convicted of or charged with a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection therewith.

Signature Date


FOCUS  3825 Presidential Parkway, Suite 103Atlanta, GA30340

Telephone: (770) 234-9111  Fax (770) 234-9131  