Internship Application — The Sensory Village Foundation

Personal Information

Full Name *

Date of Birth

Phone Number *

Email Address *

Address

City / State / ZIP

School / College (if applicable)

Current Grade / Year

Field of Study (if applicable)

Emergency Contact

Name

Relationship

Phone Number

Internship Interests

Which internship term are you applying for?

Spring (March, April, May) Summer (June, July, August) Fall (September, October, November) Winter (December, January, February)

Preferred Start Date

How many hours per week are you available?

5 - 10 hours 10 - 15 hours 15 - 20 hours 20+ hours

Are you seeking:

School Credit Volunteer Experience Professional Development Other

Areas of Interest

Experience & Background

Have you worked or volunteered with children before?

Yes No

If yes, please describe:

Do you have experience working with individuals with disabilities, sensory needs, or developmental differences?

Yes No

If yes, please describe:

References

Reference 1 - Name

Reference 1 - Relationship

Reference 1 - Phone / Email

Reference 2 - Name

Reference 2 - Relationship

Reference 2 - Phone / Email

Application Certification

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submission of this application does not guarantee acceptance into The Sensory Village Foundation Internship Program. *

Signature (type your full name) *

Date *