If you have trouble completing this form, please contact our office. * marks required fields of data. Your Information Prefix: * - Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Rev.Dr.The HonorableRabbi First Name: * MI: Last Name: * Suffix: - None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and Family Your Contact Information Street Address: * Street Address Continued: City: * State: * Zip Code: * +4 Extension: Email: * Telephone Phone Number: * Phone Type: Standard voice telephoneVideophone [VP]Text-telephone device [TTD] What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone. Permanent Address (if different) Street Address: Street Address Continued: City: State: ZIP Code: Emergency Contact Information: Emergency Contact Name: * Emergency Phone Number: * Phone Type: Standard voice telephoneVideophone [VP]Text-telephone device [TTD] Academic Information Is academic credit available for internships? Yes No Relevant if you are currently enrolled in College/University. Schools attended, beginning with your current school: * Year in School: * Graduation Date: * Year Year20202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 GPA: * Major: * Advisor's Name: * Activities/Honors: * Skills applicable to internship List specific issues or areas of interest to you: * Have you served a prior internship in Washington D.C. or in a district office? If yes, with whom? * Applicant's Additional Information Date of Birth: Year Year199619971998199920002001200220032004 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Desired Location(s): * District Office Washington DC Office Desired Session(s): * Fall Spring Summer Career Objectives: * 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: * Cover Letter: * Files must be less than 2 MB.Allowed file types: txt rtf pdf doc docx. Resume: * Files must be less than 2 MB.Allowed file types: txt rtf pdf doc docx. Your file size can not exceed 1MB. Documents must be the following file types: .doc, .docx, .pdf, .rtf, .txt Mac users: Your document must have a file extension. Resave it using your word processor with the appropriate extension from the above list.