Internship Form

Applicant's Contact Information

Prefix:

First Name:*

MI:

Last Name:*

Suffix:

Street Address:*

Street Address Continued:

City:*

State:*

Zip Code:*

Email:*

Phone Number:*

How did you hear about this internship:*

Additional Applicant Information

Date of Birth:*

Are you interested in an internship in the district or in DC?*

District Office (Paterson, NJ)
Capitol Hill Office (Washington, DC)

Desired Internship Term:*

Spring
Summer
Fall

Permanent Address (if different)
Street Address:

Street Address Continued:

City:

State:

Zip Code:

Available Days/ Times for Internship:*

Emergency Contact Information:

Emergency Contact Name:*

Phone Number:*

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:*

If you are currently enrolled in College/University, please answer the following:

Is academic credit available for internships?
Yes No

Year in School:

Graduation Date:

GPA:

Major:

Advisor's Name:*

Activities/Honors:

Career Objectives:

Names and Contact Information 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.

Please enter the relevant portions of your résumé or CV below.

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