Please Print the Following Information: Date: ______

United Way of Denton County

2016-2017 Internship Application Form

Thank you for your interest in interning with us! To help us provide you with the internship experience you are seeking, please submit the completed form along with attached resume to or another United Way of Denton County staff member.

Please print the following information: Date: ______

Name: ______Date of Birth: ______

Title First M.I. Last Suffix

Address: ______E-mail Address: ______

______Telephone Number:__(____)____-______(Home)

City: ______State: _____ Zip: ______Telephone Number:__(____)____-______(Cell)

How did you hear about United Way of Denton County?

______

Please mark which internship(s) you are interested in pursuing:

[ ] Non-Profit Management

[ ] Community Impact

[ ] Public Relations, Marketing, and Communications

[ ] Resource Development

[ ] Volunteer Management

[ ] Other - Please Describe: ______

Briefly summarize the skills and personal attributes you wish to apply and improve over the course of your internship:

______

How long do you wish to intern with United Way of Denton County? Indicate with start and stop-dates if known:

______

Are you seeking course credit with this internship? [ YES / NO ] If YES, then please fill out the following information:

University: ______Major / Minor: ______Classification: ______

Class Code (if known): ______Instructor (if known): ______Credit Hours (if known): ___

Instructor Contact (if known): E-mail: ______Telephone Number:__(____)____-______

Please detail any relevant volunteer or job experience you have had recently:

Organization: ______Position: ______Telephone Number:__(____)____-______

Duties: ______

Organization: ______Position: ______Telephone Number:__(____)____-______

Duties: ______

If you have personal or professional references, please list them below:

Name: ______Phone Number:__(____)____-______E-mail: ______

In case of emergency, please contact: ______

Name Relationship Phone Number

· I certify that the information I have supplied above is correct.

· I understand that United Way of Denton County deals with information of a confidential nature, and that I will be bound by their policies and procedures.

· United Way of Denton County has my permission to contact listed references, employers, and instructors.

Signature: ______Date: ______