RCC Internship Application

RCC Internship Application
Which internship are you applying for?
Name

First Name Middle Initial Last Name
Date of Birth

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
ALT. Phone Number
Please enter a valid phone number.
Email
example@example.com
What languages do you speak fluently?

English Spanish Other
What languages do you read and/or write?

English Spanish Other
If you are currently a client or where a former client of RCC please let us know when:
*If you are a current or former client, there are certain programs you will be ineligible for.
Employment History
Employer
Length of Employment
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer
Length of Employment
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer
Length of Employment
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Availability
When are you available to begin your internship hours?
What days are you available?

Monday Tuesday Wednesday Thursday Saturday Friday Sunday
What times are you available?

Mornings Afternoons Evenings
Internship Program Specifics
Internship Level:

Undergraduate Graduate Doctorate
University/College
Program
Practicum Supervisor
Department Chair
How many hours do you require to meet you internship requirement?
Semester(s) for which you are applying:
*If semesters require different hour requirements, please indicate.
1. Of all the places you considered as a possibility for an internship, what compelled you to seek an internship at the Resource and Crisis Center of Galveston County?
2. What goals do you want to accomplish during your internship at theResource and Crisis Center of Galveston County?
3. What relevant work and/or school experience do you bring with you?
Information you should know:
I understand that I must complete all training relevant to the assigned program and provide appropriate written references before I can work as an intern with the Resource and Crisis Center of Galveston County. I understand that the Resource and Crisis Center of Galveston County will conduct a criminal background investigation; and that I will be asked to grant written permission for that part of the internship screening process. I will receive a copy of the intern manual providing me with requirements and other important information and I assume the responsibility of reading the manual and asking for questions for clarification. I understand that I am responsible for completion of the hours required in my internship program. Supervision will be provided by the appropriate director at the Resource and Crisis Center of Galveston County. I understand that the completion of this application does not ensure placement in the internship program at the Resource and Crisis Center of Galveston County.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

RCC Internship Application

Employment History

Availability

Internship Program Specifics

Information you should know: