ExxonMobil Community Summer Jobs Program (CSJP)
AGENCY APPLICATON
Please review the accompanying Program Guidelines before you complete this application.
Also, please briefly review the application before proceeding.
In order to be considered for funding, your agency must be a 501(c)(3) Nonprofit Organization or Governmental Agency located in Harris or Montgomery County.
Your agency’s application must also be:
· Signed by the Executive Director
· Include the Submission of the Brief Online Application
· Received at the Volunteer Houston office by Tuesday, December 2nd at Noon
The brief online application must be completed and submitted here
(Located at the bottom of the webpage) for the application to be considered.
Applications (and accompanying materials) must be mailed or delivered to:
Volunteer Houston
Ashley Francis - 2015 ExxonMobil CSJP
3015 Richmond Avenue, Suite 100
Houston, Texas 77098
FAXED OR EMAILED APPLICATIONS WILL NOT BE ACCEPTED
General Information
Name of Agency (please list as it should appear in publicity materials): Click here to enter text.
Legal Agency Name (if different): Click here to enter text.
Agency Mission Statement: Click here to enter text.
Agency Street Address: Click here to enter text.
Agency City: Click here to enter text. State: Click here to enter text. Zip Code: Click here to enter text. County: Click here to enter text.
Telephone Number: Click here to enter text. Fax: Click here to enter text.
Agency Website: Click here to enter text.
Name of Executive Director: Click here to enter text.
Intern Supervisor’s Name: Click here to enter text.
Intern Supervisor’s Title: Click here to enter text.
Intern Supervisor’s Street Address, City, State and Zip (if different from agency address): Click here to enter text.
Intern Supervisor’s Phone: Click here to enter text. Extension: Click here to enter text.
Intern Supervisor’s Email Address: Click here to enter text.
Is the Intern Supervisor a paid full-time employee of the agency (The intern supervisor must be a full-time employee of the agency)? Choose an item.
How long has the Intern Supervisor been employed by the agency? Click here to enter text.
If someone other than the Executive Director or the Intern Supervisor will recruit and hire the intern, please list that person’s contact information (the intern supervisor’s participation in the hiring process is highly recommended):
Name: Click here to enter text.
Title: Click here to enter text.
Phone: Click here to enter text.. Ext: Click here to enter text.
Email Address: Click here to enter text.
Select the one category that best reflects your agency’s mission: Choose an item.
If “Other,” please explain: Click here to enter text.
Select the one employment category that best reflects the internship: Choose an item.
If “Other,” please explain: Click here to enter text.
Estimate the populations served by your agency (provide percentages):
African-American Click here to enter text. Asian Click here to enter text. Caucasian Click here to enter text. Hispanic Click here to enter text. Native American Click here to enter text. Other Click here to enter text.
Ages: 0 – 17 Click here to enter text. 18 – 29 Click here to enter text. 30 – 65 Click here to enter text. 65 + Click here to enter text.
Genders: Female Click here to enter text. Male Click here to enter text.
List the number of agency employed staff members: Full-time Click here to enter text. Part-time Click here to enter text.
Internship Information
What would be the intern’s job title? Click here to enter text.
Briefly describe the internship in 2-3 sentences: Click here to enter text.
Summarize the intern’s job responsibilities with an attached job description. Include a detailed description of the program and/or project or area for which the intern will have primary responsibility and a full explanation of the intern’s role and duties.
In the event your intern completes their assigned project early, please briefly describe 2 additional projects for the intern to complete in 2-4 sentences: Click here to enter text.
Identify the preferred schedule for the internship (35 hours per week for an 8-week period).
The 8-weeks must begin on or after June 1 and must end by August 31 and the weeks must be consecutive.
Preferred internship start date: Click here to enter text. Preferred internship end date: Click here to enter text.
Number of workdays each week: Click here to enter text. Number of hours each workday: Click here to enter text.
Describe how you will recruit an intern: Click here to enter text.
Briefly describe additional recruitment methods if you encounter difficulty finding the best candidate (this is in addition to Volunteer Houston’s assistance): Click here to enter text.
Describe the skills a college student would learn or develop through this internship below:
Communication Skills: Click here to enter text.
Management/Administrative Skills: Click here to enter text.
Professional Skills: Click here to enter text.
Technical Skills: Click here to enter text.
Other Skills or Competencies: Click here to enter text.
Experience has shown that the most valuable internship includes a thorough and complete intern orientation to the overall work of the nonprofit agency. Please check the elements that would be included in your orientation (click box to select):
Tour of agency facilities ☐
Presentation of agency’s history, mission and goals ☐
Personal introductions to agency staff members ☐
Opportunity for interaction with volunteers and clients/patients/patrons ☐
One-on-one time with the agency executive director ☐
Opportunity to attend an agency board meeting ☐
Presentation of agency budgeting/fundraising processes ☐
Explanation of payroll process (including tax withholding) ☐
Overview of office procedures (expense reporting, mail, etc.) ☐
Intern will be provided with his/her own desk/office/workspace ☐
Intern will be provided with a computer (if required for job) ☐
Supervisor will clearly state his/her expectations of intern ☐
Discussion of intern’s learning goals for the internship ☐
Discussion of how the learning goals would be met ☐
Reading assignments related to the field ☐
Opportunities for training / professional development ☐
List any specific training to be included during the internship (such as software, safety, leadership, or client relations, etc.): Click here to enter text.
Describe how the supervisor will monitor the intern’s work performance: Click here to enter text.
Describe how the supervisor will encourage the intern’s progress toward achieving their learning goals for the internship: Click here to enter text.
Describe how your agency will handle payroll for the intern: Click here to enter text.
Describe how your agency would handle any business-related expenses incurred by the intern (mileage, parking fees, etc.): Click here to enter text.
If your agency would choose to pay the intern more than the amount of the grant stipend, please indicate the additional amount (or, if full amount is unknown, then indicate the hourly or weekly rate upon which you would base the additional payment): Click here to enter text.
Does your agency plan to hire additional interns this summer? Choose an item. If yes, briefly describe the type of internship(s): Click here to enter text.
If your agency is selected, do you agree:
To effectively communicate with Volunteer Houston in a timely manner during the program? Choose an item.
To be available during the summer for any questions or concerns from Volunteer Houston? Choose an item.
To send the intern’s supervisor to the Agency Orientation in February? Choose an item.
To place the Volunteer Houston and ExxonMobil CSJP logo on your agency website? Choose an item.
To send agency staff and/or board representatives to the Program Kickoff in June? Choose an item.
To allow your intern paid-time off from the office to attend two half-day Development Seminars and a half-day Community Service Project? Choose an item.
To be accommodating and make the mandatory program site visit conducted by Volunteer Houston a high priority? Choose an item.
Does the supervisor (or the Executive Director, in the absence of the supervisor) agree to meet with the Volunteer Houston staff for a site visit during the internship? Choose an item.
Do you certify that your nonprofit status has not been revoked and is still in effect? Choose an item.
Does your agency agree to the disclaimer and assumption of responsibility set out in the attached guidelines? Choose an item.
This application must include the following attachments and submissions (click box to select):
☐ A copy of the letter from the Internal Revenue Service stating the agency’s federal tax- exempt 501(c)(3) status. Texas Sales and Use Tax Exemption Certificate is not sufficient.
☐ A copy of your most recent audited financial statement or IRS Form 990.
☐ A copy of your agency’s mission statement and/or agency brochure.
☐ A copy of the detailed intern job description.
☐ Submission of the brief online agency application here.
Name of Agency: Click here to enter text.
Name of Executive Director: Click here to enter text.
Signature of Executive Director: __________________________________ Date: ___________
Selected agencies will be notified by January 9th. Thank you for your application!
2015 ExxonMobil CSJP Agency Application Page 2 of 5