Intern Application

First name: *

Last name: *

Street address: *

City: *

Zip: *

Home phone: *

Work phone: *

Cell phone: *

Email: *

Emergency contact name: *

Emergency contact relationship: *

Emergency contact phone: *

Birthdate

Ethnicity (You may optionally provide the following information. It is used only to help us understand the demographic make-up of our volunteers.)

Type of Internship *

Area of Interest for Internship *

Explain why you are interested in a science internship: *

Proposed dates of internship *

If referred by a current volunteer or SDNHM staff member, please provide name:

Highest level of education completed (Must be high school junior or above.): *

Name of school: *

Will you receive course credit for this internship? *

Major or coursework related to natural history: *

High school students, have you taken general biology? *

Previous work and volunteer experience. Please provide details on duties performed: *

Skills and hobbies related to natural history: *

Teacher Reference: *

Teacher Email: *

2nd Reference (Please provide the name of a former employer, teacher, or supervisor for volunteer work.): *

2nd Reference Email: *

For high school students, provide Parent/Guardian Name:

Parent/Guardian Phone Number:

Additional Comments:

I certify that this information is correct. I understand a background check may be performed.

Please type the letters and numbers shown in the image.