Rocky Creek / Discovery Trail Internship Application [040416]

INTERNSHIP APPLICATION

All individuals interested in interning with Sexual Violence Resource Center of the Bluegrass (SVRCBG) must complete this application in full. Items marked with an asterisk require a response.

Note: This is an unpaid internship
CONTACT INFORMATION
Today's Date*

MonthDayYear
Name

First NameLast Name
Preferred Gender Pronouns

she, her, hershe, him, histhey, them, theirsOther
Phone*
E-mail Address*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ELIGIBILITY INFORMATION
Date of Birth*

MonthDayYear
Interns must be at least 18 years of age
Do you have reliable transportation?*

YesNo
Do you have an active driver's license and car insurance?*

YesNo
Do you have access to a personal phone?*

YesNo
Have you ever been a client with SVRCBG?*

YesNo
When were you a client?
Why are you interested in an internship at SVRC Bluegrass?*
INTERNSHIP INFORMATION
What school do you attend?
Does your institution have a Memorandum of Understanding (MOU) with SVRC Bluegrass? If you do not know, who should we contact from your department to formalize working together?
What is your degree level?
(bachelors/masters of ____)
What is your major?
When do you expect to graduate?
What semester are you interested in interning with us?*

SpringSummerFallWinterOther
Of what year?
What are your anticipated start and end dates?
(Or, what date does your semester start and end?)
What days and times of the week are you available for your internship hours?
How many internship hours will you need to complete for the semester?
Please note that the first 40 hours of any internship consists of victim advocacy training
What specific goals are you hoping to accomplish during your internship? Are there certain areas you would like to focus on?*
Which (if any) of the following sound the most fitting or enjoyable for you?

Curriculum developmentSocial Media and MarketingAdmin tasks (filing, organizing, etc.)FundraisingOther
What type of activities are you interested in doing? What kinds of things are you hoping to learn?
What is your availability or desired days/times to work? AM shifts are 9-1 and PM shifts are 1-5.[check all that apply]*

Monday AMMonday PMTuesday AMTuesday PMWednesday AMWednesday PMThursday AMThursday PMFriday AMFriday PMOther
SVRC of the Bluegrass is the designated Rape Crisis Center for Central Kentucky. We value holistic well-being, health, and longevity for our staff, volunteers, and interns. We support survivors by listening to their stories of sexual violence and trauma, which can be difficult to hear and may have negative impacts on mental health. Do you have any concerns about working in a in a fast-paced environment with potential exposure to secondary trauma?
Is there any other additional information that you would like to share with us? Are there any qualities that you possess that are not addressed in this application that you feel are important to share?*
How did you find out about our internship program?*
REFERENCES

Please list three references (other than relatives or SVRCBG staff) that we may contact. One MUST be a professional reference (e.g. Supervisor, Professor, etc.).
Reference 1

First NameLast Name
Email*
example@example.com
Relation
Reference 2

First NameLast Name
Email*
example@example.com
Relation
Reference 3

First NameLast Name
Email*
example@example.com
Relation
BACKGROUND CHECKS

SVRCBG is required by the Kentucky Administrative Statutes on Rape Crisis Centers to run a background check on all staff and volunteers. Offenses that may disqualify an applicant include violent offenses and offenses against children.
Have you ever been convicted, imprisoned or fined for a felony?*

YesNo
If yes, please explain. Give dates and locations.
Please upload your resume or CV in PDF form here*

Browse Files

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CERTIFICATION OF APPLICANT

I certify that all answers to the questions in this application are true and I further understand that any false statement in this application will be sufficient grounds of rejection of the application or termination of employment/volunteer status without notice at any time hereafter. I authorize the Sexual Violence Resource Center of the Bluegrass to complete a criminal background check if I have applied to a position subject to this requirement. I understand that the findings of a record check may be grounds for rejection of application or termination of employment/volunteer status without notice. I authorize the Sexual Violence Resource Center of the Bluegrass to make all necessary investigations to verifying information contained herein, and authorize and release from liability and and all references to provide information relevant to my application for employment or volunteering.

I certify that my electronic signature is the equivalent of my manual signature on this document.
Name of Applicant*
Date*
(MM/DD/YYYY)
Thank you for taking interest in our Internship Program. We will be in touch shortly. If you have any questions, please don't hesitate to contact Dr. Amanda Allen at aallen@SVRCKentucky.org
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INTERNSHIP APPLICATION