Student Internship Application

Contact Details

First Name

Last Name

Mobile Phone

Opt-In for Text Communication

Yes

Street Address

City

State

Zip Code

Are you or have you been a Willow House Family Member? (i.e. have you attended / signed up to receive group support services?)

YesNo

Internship Application

School/Program

Year in the Program

Concentration

Preferred Internship Start/End Dates:

Availability at Willow House:

Professional Goals:

How did you learn about intern opportunities with Willow House?

Why are you interested in completing an internship at Willow House?

How do you feel an internship at Willow House will support your school work and professional goals?

Please describe your personal and professional experiences working with children and/or teens. Please specify age and duration.

Have you experienced the death of a family member or close friend?

YesNo

If yes, how long has it been since the death(s)? Please also describe how the person(s) in your life died and how you coped with the experience(s):

How would your personal, professional and academic experience enhance your role as an intern at Willow House?

Have you ever been convicted of any felonies or misdemeanors other than for minor traffic offenses?

YesNo

If yes, please explain:

Please list and special skills/talents you have that may be helpful to Willow House.

Any additional comments, concerns, or questions.

Resume

Resume/CV Upload

Signature

Willow House requires that background checks be completed for all volunteers who are working directly with Willow House children and teens in the program setting. Your signature below indicates your understanding of this volunteer policy and your agreement to your name being submitted for a background check following your completion of the training.

Signature (Type Full Name)

Date

Hidden Fields

Volunteer Contact Record Type Id

WH Family Member Contact Record Type Id

Intern Case Record Type Id

Contact Information