INTERNSHIP APPLICATION

Name:

Date:

Present Address:

City, State Zip:

Day Phone:

Evening Phone:

Email:

Permanent Address:

City, State Zip:

Emergency Contact:

Phone:

Name of School:

School Address:

City, State Zip:

Year In School:

Area(s) of study:

Currently employed? Yes No

Past job experiences:

How did you hear about PATH?

Are you interested in a part-time or full-time internship?

Part-time Full-time

Availability: Daytime Evening Weekend

Do you plan to have a part-tme job during your internship? Yes No

If yes, how many hours a week do you plan to work?

Previous volunteer experience:

Languages spoken:

Optional Personal Data

Date of Birth:

Sex: Male Female Transgender

Ethnicity:

African American
Asian / Pacific Islander
Latino(a)
Native American
White
Mixed / Biracial / Multiracial
Other Ethnicity (please specify):

Which Internship(s) are you interested in:

Case Managerment**
Research
Graphic Art / Visual Display
Research Writer *
Administrative / Clerical / Data Entry
Outreach / Education
Operations (food services, custodial)
Volunteer Services
* Please email two writing samples
** Requires a minimum 3 month commitment

Internship start date:

Internship ending date:

Please describe your qualifications for the internship for which you are applying:

Why do you want to intern with PATH?

What are your goals of this internship and how do they work with your future plans?

Oath of Confidentiality:

As an intern with P.A.T.H., I may learn confidential information of persons I have contact with in the course of my work. I understand that some people are public about their personal information, however most are not. I agree to respect the right to privacy of all persons. I pledge to maintain complete confidentiality of all names, addresses, files, office records and internal memos and procedures I encounter in my work at P.A.T.H. I also pledge not to reveal to any person outside the organization the name of any person who donates money or contributes other services to P.A.T.H. I affirm that I am not any employee or agent of any law enforcement, investigative, or regulatory agency of any government entity, or that I am working under any contract for any such agency. I further affirm that I am not employed by or in any way connected to any news-gathering organization, newspaper, television or radio station, or any other type of mass medium.

Signed:

Date:

Thank you for taking the time to fill out this form. Feel free to email your resume (to kais@epath.org) or add anything else you think might be relevant on the back page of this profile. Please send all additional information to:

People Assisting The Homeless- West Los Angeles
Attention: Kai Stansberry
2346 Cotner Avenue
West Los Angeles, CA 90064