Internship Application

Please fill out the following information and return to:

American Red Cross of the Chesapeake Region

ATTN: Office of Volunteers

4800 Mt. Hope Dr. Baltimore, MD 21215

410.624.2013

Applicant Information
Name: Last / First: / Date:
Street Address: / Apt/Unit:
City: / State: / Zip:
Phone: / Date of Birth:
Email:
Have you ever been convicted of a felony?
Yes No / Do you consent to a criminal background check? Yes No
How did you hear about our internship program?
Availability
Please check semesters of availability:
Fall Spring Summer Other, please explain:
Please check your general availability / Monday / Tuesday / Wednesday / Thursday / Friday
Morning (8:30-1)
Evening (1-5)
Area(s) of Interest
Please indicate which area interests you:
Office of Volunteers / Communications/PR / Outreach & Education
Finance/Development / Health & Safety / Service to the Armed Forces
Nursing Program / Emergency Services / Other, please explain:
Experience/Education and Skills
Current employment status: Full-time Part-time Not Employed
Current employer and position held
Are you currently a full-time student?
Yes No / If yes, please indicate school and concentration:
Level / Area(s) of study:
Freshmen / Sophomore / Junior
Senior / Graduate student
Do you speak any other languages?
Yes No / If yes, please list language
Fluent Semi-Fluent Basic
Computer Skills/Software Used:
Personal Information
Why are you interested in an internship with the American Red Cross?
What specific experience would you like to gain through this internship?
Please describe your long-term career goals:
Internship Criteria
Hourly requirements?
Beginning and end dates? Total number of weeks?
School requirements? i.e. supervision, reports, assessments
Other
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to an internship assignment, I understand that false or misleading information in my application may result in my release.
Signature: / Date: