Area 10 Agency on Aging is an equal opportunity employer and will not discriminate, or tolerate discrimination, against any applicant in any manner prohibited by law. Internship Application Step 1 of 5 - About You 20% Name First Last Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code UniversityDegree/MajorDo you have reliable transportation?YesNoEmergency ContactName First Last PhoneRelation Length of Internship Sought:Desired Start Date: Desired End Date: AvailabilityInternship Opportunity DesiredIf undecided about specific internship position, please choose a program area that you would be interested in. Caring Companions Endwright Center Development/Fundraising Marketing/Web/Graphic Design Mobile Food Pantry Nutrition Program Undecided Please check all that apply.Please describe any relevant skills and expertise you would bring to Area 10 with this internship.Please explain the type of activities or projects required for your program.If this internship will help to complete university requirements, please explain the type of activities or projects required for your program, including the level of mentoring or supervising required, and other relevant information (course, professor, etc.) to help us determine if this internship would be a good fit. Employer 1Most Recent Position:EmployerEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor Name First Last Start Date End Date Employer PhoneDescription of DutiesEmployer 2Position:EmployerEmployer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor Name First Last Start Date End Date Employer PhoneDescription of Duties Reference 1Name First Last PhoneEmail RelationshipKnown how long?Reference 2Name First Last PhoneEmail RelationshipKnown how long?Reference 3Name First Last PhoneEmail RelationshipKnown how long? I verify that all of the information above is correct and true to the best of my knowledge. I am interested in interning at Area 10. I understand that all information is kept strictly confidential. I give Area 10 the right to investigate all references. I hereby release the use of my photograph, and understand that the photograph may be used for a variety of purposes, including, but not limited to, newspapers, websites, brochures, and newsletters. I release Area 10 Agency on Aging from any claim which may arise from participation in Area 10 activities. My signature also verifies my permission to run a criminal background. I agree to notify Area 10 immediately if anything changes that would affect the results of my background check.SignatureDate NameThis field is for validation purposes and should be left unchanged.