Work Study and Internship
Application
*
Required Fields
Your Contact Information
*
First Name
*Required
Middle Name
*
Last Name
*Required
*
Current Address
*Required
Apt. #
*
City
*Required
*
State/Province
*Required
*
Zip/Postal Code
*Required
Home Phone
*
Email
*Required
Your entry is not a valid email address!
*
Date of Birth
(mm/dd/yyyy)
mm/dd/yyyy
mm/dd/yyyy
*
Social Security (required for all background checks)
*Required
College or University
Major/Concentration
Degree awarded or working toward
Graduation or anticipated Graduation Date
Have you been a member, or a volunteer or employed at any Boys & Girls Club?
If yes, where and when:
Do you speak Spanish?
Yes
No
Internship Information
Internship(s) for which you are applying - check all that apply:
Marketing & Resource Development
Event Planning & Volunteer Management
Sports, Fitness & Recreation Programs
The Arts Programs
Education & Career Development Programs
Academic Intervention Intern
Other
Term(s)
Spring (January - April)
Summer (June - August)
Fall (September - December)
Are you seeking academic credit for this internship?
*
Hours Needed
*Required
Location
Please indicate which Club you are interested in - check all that apply:
Raleigh Girls Club
Raleigh Boys Club
The Club - Teen Center
Brentwood Boys & Girls Club
Washington Elementary Boys & Girls Club
Parrish Manor Boys & Girls Club
Wake Forest Boys & Girls Club
Zebulon Boys & Girls Club
Additional Information
Do your currently use illegal drugs?
If yes, please explain here:
Have you ever been convicted of child abuse or neglect or is there a pending charge against you for child abuse or neglect?
If yes, please explain here:
Have you ever been convicted of a criminal offense?
If yes, please explain here:
Personal Statement
Please write a statement addressing your academic and career goals.
Relevant Work
Please provide relevant work and coursework experiences and other experience that relate to the internship:
Understanding
Understanding and Authorization:
I certify that all the answers on the application and any attachments are true and complete to the best of my knowledge. I also certify that I have not withheld any pertinent information. I agree that in the course of considering my application, you may inquire to verify information considering my background. I specifically authorize you to investigate all statements in the application. I authorize educational institutions, employers and references listed above to give you any and all information concerning my education, employement and fitness to work with children and young people.
I further agree to release and hold harmless the Boys & Girls Clubs, institutions, references listed above and any law enforement agencies from all liability and any damage that may result from furnishing this information to you.
I certify this statement
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