hsc internship application

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hsc internship application
HSC Foundation Internship Application Form
1. CONTACT INFORMATION
Name:
Last, First, Middle Initial
Current Address:
Permanent Address
(if different from Current Address)
Street
Street
Apt./P.O. Box
Apt./P.O. Box
City, State/Province Zip Code
City, State/Province Zip Code
Phone Number
Phone Number
Alternate Phone Number
Alternate Phone Number
E-mail Address:
2. CERTIFICATION
I certify that the information contained on this form and in my application package is true and
complete to the best of my knowledge.
Signature:
Date:
If you are not your own legal guardian, please have a parent or legal guardian sign below.
Signature:
Date:
3. INTERNSHIP OPPORTUNITIES
Please see descriptions, qualifications, and application requirements for each placement.
I would like to be considered for the following placements (please list job title below):
1.
2.
3.
HSC Internship Application
Page 1 of 5
4. PROGRAM ELIGIBILITY
The following information is collected in order to ensure each applicant’s eligibility for the
program. Applicants may authorize the Kennedy Center to disclose information regarding
disability or chronic illness to placement sites at various points in the process. Unless the
applicant specifically requests that the Kennedy Center disclose information regarding
disability or chronic illness to potential placement sites, this information will remain confidential
and will only be used to provide accommodations during the interview process.
DATE OF BIRTH
/ /
MM/DD/YYYY
DOCUMENTATION OF DISABILITY OR CHRONIC ILLNESS
What is your disability or chronic illness?
What accommodations, if any, would you need for an interview?
(For example: wheelchair accessibility, sign language interpreter, large print materials, etc.)
DISCLOSURE
If you would like to disclose information regarding your disability or chronic illness to the
placement sites, please indicate so below. As noted above, information regarding disability
and chronic illness will remain confidential unless one of these boxes is selected.
Please disclose my disability/chronic illness only if I have been offered and accepted
an internship.
Please disclose my disability/chronic illness if I am invited for an interview.
Please forward this form as a part of my application.
Signature:
Date:
If you are not your own legal guardian, please have a parent or legal guardian sign below.
Signature:
HSC Internship Application
Date:
Page 3
5. EDUCATION
HIGH SCHOOL
Name of High School:
Current Status:
Freshman
Sophomore
Junior
Senior
I received a Diploma
I received a Certificate
I received my GED
I did not graduate
COLLEGE/UNIVERSITY
Name of College/University:
Current Status:
Freshman
Sophomore
Junior
Senior
Graduated in
I did not graduate.
(MM/YYYY)
What degree did you receive or are you working towards?
Major:
Minor:
GPA:
OTHER EDUCATIONAL EXPERIENCE
Please briefly describe any other education or training experience below.
HSC Internship Application
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6. WRITTEN QUESTIONS
Please enter your responses in the gray boxes below. If you need additional space, you may
write your answers on a separate piece of paper and attach it to this application.
Briefly state your career goals.
How will an internship in a cultural arts organization help you to achieve your career
goals?
What qualities, skills, experiences, and interests make you the best candidate for this
internship?
What are your personal strengths and weaknesses?
HSC Internship Application
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WRITTEN QUESTIONS continued
HSC Internship Application
Page 5 of 5

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