Advocacy Internship Application Personal InformationName* First Last Pronouns*She/ her/ hersHe/ him/ hisThey/ them/ theirsOtherPrefer not to answerAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Are you 18 years of age or older?*YesNoOther Required InformationPlease provide the name of your college/university:*Major or area of study:*Are you applying for this internship for course credit?*YesNoPlease briefly describe your internship requirements (ie. Supervisor credentials, required number of internship hours, specific program requirements, supervision hours, etc.):*When are you available to start?* Date Format: MM slash DD slash YYYY DARCC requires interns to commit to at least one semester, which is a combination of on-call and in-person office hours. Advocacy interns are also required to respond to medical accompaniment calls with any of DARCC's affiliated hospitals during assigned shifts. You are required to provide your own transportation. Can you make this commitment? If you have any concerns, please specify.*YesNoI am seeking an internship for the...* Fall Semester Spring Semester Summer Semester Have you ever received services from DARCC?*YesNoUnsureDARCC requires interns to have liability insurance through their university and/or personal liability insurance. Is this something you can agree to?*YesNoAre you bilingual? If so, please specify what other languages you are fluent in.*