Community Engagement 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:*Please briefly describe your internship requirements (ie. Supervisor credentials, required number of internship hours, specific program requirements, supervision hours, etc.):*When would you be available to start?* Date Format: MM slash DD slash YYYY I am seeking an internship for the...* Fall Semester Spring Semester Summer Semester Are you interested in a virtual, hybrid, or in-person internship?* Virtual Hybrid In-Person Check all that apply.Which internship opportunity are you interested in?* Social Media Community Engagement Outreach and Prevention Check all that apply.DARCC 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.*
