DEPARTMENT OF VETERANS AFFAIRS
NATIONAL DIVERSITY INTERNSHIP PROGRAM
FY 2018 MENTOR APPLICATION INSTRUCTIONS
All fields MUST be completed and all required documents must be attached in order for your application to be considered complete. You may return to the application at any time to edit and attach documents prior to submission by selecting the Save button in the upper left hand corner of the application.
A SEPARATE APPLCATION IS REQUIRED FOR EACH INTERN YOU ARE REQUESTING
Section I: Fiscal Information
Date of Application - Select the date from the calendar. MM/DD/YYYY
Internship Session - Designate the session the internship is requested. You can only select one session - Spring, Summer, or Fall
Fiscal Year -Select the fiscal year of the application from the drop down menu.
Organization Name - Select the organization/station number from the drop down menu where the internship will occur.
VA Administration - Indicate Mentor VA Administration affiliation. Staff offices that are not within an Administration (VHA, VBA, OIT, or NCA), will select VACO. Example: VHA VACO will select “VHA”.
Funding Organization - Select the funding source for the internship from the drop down menu. If you are requesting funding from your Administration, please select VHA, NCA, or VBA as appropriate. If your office will provide its own funding, check the Self-funded block.
(Example: The Office of Research and Development or VAMC Washington DC will provide funding for the internship session).
If Administration funding is determined to be unavailable, you have three (3) business day to provide a signed funding document (VA Form 90-2237) by attaching the document to your online application.
Applications received without funding documents will be considered incomplete and disapproved.
Budget Personnel Name: Please list the name of the budget/finance POC for this action. It is imperative that the funding document is obligated and transmitted via the IFCAP system. Additionally, the Accountable Officer of your organization must also sign and electronically transmit the funding documents in order for documents to be received by the Contracting Office.
Budget Personnel Phone: Please list the direct number of the budget/finance POC for this action.
Budget Personnel Email: Please list the email of the budget/finance POC for this action.
Section II: Organization and Mentor Information
Brief overview of the Organization/Office Mission - Provide a brief overview of the organizational or office mission. This is an opportunity to provide information to the intern about what the office does in support of the overall VA mission. This information is important to the intern to determine if the offered internship opportunity is beneficial and will afford them the opportunity to expand their career.
Internship Location
Office Name - Provide the name of the office where the internship will occur. (Office of Enterprise Support Services, Equal Employment Office, Orthotics)
Office Code - Fully identify the Office code. (10NA1, 06, 006, etc.)
Room/Suite number (if applicable) Room 200
Street Address: - List the actual address where internship will occur
Steet Address 2: (to include building number and name)
City:
State:
Zip code:
Availability of Public Transportation -Indicate if public transportation to the internship worksite is available.
Availability of housing on the VA campus - Indicate if housing is available on the VA campus.
Housing or Transportation Comments: If you have suggestions, please provide any helpful information that will assist the referring vendor in securing adequate housing or transportation. Example: Car needed, suggested housing areas, airports, or other items that will ease commuting options for an intern not familiar with the area.
Mentor Information
Identify the VA individual who will provide daily supervision to the intern and is responsible for work assignments, development, and certifying the intern’s time and attendance. The primary and alternate mentors are the individuals who will make intern selections and receive all information from the program and contract office during the internship session.
Mentor - Ensure the Mentor’s full name, direct phone number, and email address is provided.
Alternate Mentor – Identify the alternate person who will act in place of the mentor, to provide daily supervision to the intern and is responsible for work assignments, development, and accounting for the intern’s time and attendance. Ensure the alternate POC’s full name, direct phone number, and email address is provided.
AN ALTERNATE MENTOR IS REQUIRED. APPLICATIONS THAT DO NOT HAVE AN ALTERNATE MENTOR WILL BE DISAPPROVED.
Section III: Internship Project/Task and Desired Intern Qualifications
Desired Major - Identify the desired Academic Major(s) of the intern. If specific academic major(s) is specified the duty description should support the request.
Desired Minor – Select a minor from the drop down menu.
Intern Academic Level –Indicate the preferred academic level of the intern. Choose only one level. Undergraduate, Graduate, Professional, Doctorate. Carefully determine the appropriate academic level that complements the skillset requested for the work that is to be performed. For request at the Graduate level, the internship opportunity must justify a Graduate or Professional/Doctoral level intern.
Desired Intern Qualifications
Specify the preferred Intern performance skills – Select all applicable to the internship.
o Ability to gather and analyze data to identify significant factors
o Experience using computer and automated systems to manage data, to include MS Office Products (Word, PowerPoint, Excel, Outlook) If you need Access, Publisher, SharePoint, etc specify in Additional Skills section below
o Ability to prepare and present briefings - consider school experience
Additional Skills - Itemize additional intern performance skills desired – if there are additional skills desired specify.
Description of Project Tasks/Assignment - Provide a list of project tasks or assignments that the intern will be working on over the course of their internship. Please provide as much detail as possible as this information is provided to the intern and will determine if this internship opportunity is a good fit for them. If exact work is unknown, provide examples of the work your office performs. Please keep in mind that the benefit to the Intern is that he/she will gain career related experience, have an opportunity to explore career avenues and gain valuable work experience.
Mentor Agreement
In order for your application to be considered complete, you must attach a signed Mentor Agreement.The Primary andAlternate MentorsMUST sign the agreement ANDobtain the signature of theOrganizationAuthorizingOfficial. VA has many different organizational structures therefore, it is difficult to dictate who should be the Organizational Authorizing Official for all VA employees.The intent is for the requesting office to obtain the signature of the appropriate official based upon their organizational structure.
Attachment Instructions - To attach a document:
1) Complete entire form.
2) Click the attachment box.
3) Select browse.
4) Select a file, and then click open to upload selected file.
5) Once file has been uploaded click attach.
The attachment will appear below the attachment box.
Section IV: Application Contract Options
NDIP Mentors may request interns to participate in the Spring, Summer and Fall sessions.Occasionally, some offices have projects that may last an additional internship session. If the VA office has funding AND a bona fide requirement for an additional internship session, you MUST request a contract option at the time of submission of your application.
Adding a contract option to your request allows the requesting office to continue the internship into the next session, provided the intern remains eligible. Offices requesting contract options will be contacted by the contracting specialist to determine if they would like to exercise the contract option. In order to exercise the contract option, the requesting office will be required to provide funding, and indicate that the current period of performance has been satisfactory. Upon receipt of documentation, the contracting office will contact the interns vendor who will provide confirmation of the intern’s availability for another session. If the intern is not available, the referring vendor will provide suitable replacements for the Mentor’s selection.
If a contract option is not requested at the time of submission of the application, it cannot be added later. Mentors requesting to participate in the following internship session will be required to submit a new application.
Section V: Application Status
This section is for Program and Contracting use only. Once your application has been processed by the respective program and contracting offices, information regarding the status of your application and intern confirmation data will be populated for your view.
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APPLICATIONS THAT ARE INCOMPLETE WILL NOT BE CONSIDERED