Name:

College:

Campus Phone:

(Your phone number at school)

Campus Address:

Email:

City, State:

Home Phone:

Cell Phone:

Home Address (if different):

Other Colleges or Universities attended
(City, State, Dates Attended):

Academic Level:
(Current year in College or Graduate school completed)

Major of study


Minor of study

Internship Start Date:

Internship End Date:

Area of Interest:

Possible Placements Desired
(List organizations, agencies, companies by name or type if you have any in mind):

International Students and non-U.S. citizens: Select status or expected status at time of internship and Country of citizenship:

F-1 Student J-1 Permanent Resident Other

Country

APPLICANTS SHOULD COMPLETE THIS FORM AND INCLUDE A CHECK OR MONEY ORDER FOR $1,000 (MADE OUT TO THE WASHINGTON INTERNSHIP PROGRAM), WHICH WILL BE RETURNED SHOULD THE APPLICANT NOT BE ACCEPTED INTO THE PROGRAM. ALTERNATIVELY, PAYMENT FOR TUITION CAN BE MADE BY CREDIT CARD ($1,030 ON VISA, MASTER CARD, OR AMERICAN EXPRESS) THROUGH PAY-PAL ON THE FIRST PAGE OF THE WEBSITE: (WWW.WASHINGTONINTERNSHIP.COM).
CHECK THE FOLLOWING BOX IF CREDIT-CARD PAYMENT HAS BEEN MADE THROUGH PAY-PAL. INCLUDING A RESUME IS RECOMMENDED BUT NOT REQUIRED.

APPLICANT BACKGROUND
Educational Institutions Attended

Name of School:

City, State:

Dates of Attendance / Degree Received / Expected:

GRADUATE/PROFESIONAL SCHOOL

Name of School:

City, State:

Dates of Attendance / Degree Received / Expected:

EXPERIENCE PAID AND VOLUNTEER
Include job title, name, and location of employer; dates of employment, and a brief description of duties:

SPECIAL SKILLS (Computer, Foreign Languages, etc.)

AWARDS (Academic, professional, and other)

PERSONAL STATEMENT:
Note: this section is not required but strongly recommended.

REFERENCES:
(Name, Affiliation, Address, and Phone Number):

HOUSING: Do you wish to live in WIP housing?
If yes, please list price range, housing type, and location (if known):

Name one experience in your life that made you grow as a person, and how could you use that experience to aid you in your internship.
(250 words or less)

Please describe how this internship will further your career goals.
(250 words or less)

PLACES TRAVELED (both work and leisure)

EXTRACURRICULAR ACTIVITIES

APTITUDE & PERFORMANCE
Knowing the temperament of the individual helps insure the right match.

Have you ever been subjected to academic or disciplinary action
(i.e., Probation, suspension, dismissal) from any institution attended? 

Yes
No

If yes, please provide details, dates and circumstances

Yes
No

If yes, state the name used:

How did you hear about the program?

Monster.com/Monstertrak.com

Friend/Family

E-mail    

Career Counselor

Fellow (or former) intern in the program     

Jobposting.net/.com    

careerbuilder.com

Hotjobs.com    

on-campus information session     

info-table    

internet search

Recruiter:

Other:

Program costs:
The complete cost of $3,400 includes:
$1,000 First payment (applied to tuition), and due with application; it is refundable ONLY if you are not accepted into the program.
$1,400 Second payment, due upon receiving your first internship offer.
$ 1,000 Third payment, due a month prior to start of internship or seminar, whichever comes first.

I have reviewed the above information, and it is true and complete to the best of my knowledge. This application cannot be processed without your signature.

Signature:

Date: