Internship Form

Internship Application

Note: Fields marked with an * are required.

Contact Information

Prefix

First Name *

Middle

Last Name *

Suffix

Street Address *

Street Address Continued

City *

State *

Zip Code *

Email Address *

Telephone

Telephone Number *

Phone Type *

What are these options?

This is to help the constituents that are hard of hearing or use a video phone alert us to that fact so we can use the proper technology when we need to call them. The default option “Voice” is a normal audible telephone.

Applicant's Additional Information

Preferred Office Location *

District

What Dates Are You Available?

Start Date *

Availability End Date *

If offered the internship, what is your estimated weekly availability? (Please include weekly days and times of availability. Our office hours are generally Monday-Friday 9AM-5PM) *

Permanent Address (if different)

Street Address

City

State *

Zip Code

Emergency Contact Information

Emergency Contact Name *

Telephone Number *

Phone Type *

Skills applicable to internship

List specific issues and areas of interest to you

Have you served a prior internship in Washington D.C. or in a district office? If yes, with whom?

Academic Information

Schools attended, beginning with your current school *

Are you seeking academic credit for this internship?

Yes

Year in School

Graduation Date

GPA

Major

Activities/Honors

Career Objectives

Advisor's Name

Names and Addresses of Three References *

Please use this box to write a brief paragraph about yourself, including the reasons why you would like to intern in a congressional office. *

Human Validation

Internship Form

Internship Application

Permanent Address (if different)

Office Locations

Washington, D.C. Office

Glenside District Office

Norristown District Office