KidPOWER/ YouthPOWER Intern Application

KidPOWER | YouthPOWER Intern Application

All information on this form is kept confidential. The information you provide may be used to help access where we will position you. Please complete the form in its entirety.
Name:*

First NameMiddle NameLast Name
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
Email Address:*
Email Address:
Birth Date:*

MonthDayYear
Gender:*

MaleFemale
How many hours does your internship require?
Hours per week/Hours total
When must your hours be completed by?
Hours per week/Hours total
How did you hear about the KidPOWER internship?

Criminal Background & Drug/Alcohol History
Current Employer:*
Have you ever used illegal drugs? *

YesNo
Please provide the month and year you last used. *
Are there any pending criminal charges against you? *

YesNo
Please explain.*
Have you ever been convicted of a felony offense?*

YesNo
Please explain.*

CrossBRIDGE offers several opportunities to be involved as an intern.

KidPOWER: KidPOWER is an afterschool program that offers tutoring and mentoring to students. KidPOWER meets 4 times a week, Monday-Thursday from 3:30-6:30. You would be able to participate in the program from 4:30-6:00 on those days. This program serves 1st-4th graders. Your involvement would consist of being a classroom aide and spending time in the gym with students.

YouthPOWER: YouthPOWER is a follow-up program from the KidPOWER program. This program's intentions are to continue interacting with student and developing relationships with them. YouthPOWER meets twice a week on Sundays and Wednesday from 4:30-7:30. This program currently has 5th-9th graders. As an intern at YouthPOWER, you would be spending time with students, helping with any homework they have, and building relationships with students.

Administrative Assistant: Duties would consist of, but are not limited to: planning curriculum for programs, data management, and assisting in fundraisers and events.
Where would you like to be involved at CrossBRIDGE? Click all that apply

KidPOWERYouthPOWERAdministrative Assistance
What experience have you had in working with youth?*
What recreational activities do you participate in? *
What other interests or hobbies do you have?*
Why is volunteering at KidPOWER important to you? *
What are you hoping to learn during your internship?
What skills and experience can you offer to KidPOWER/YouthPOWER programming?

References

Please provide the names and email addresses of two individuals who know you well and can attest to your character, skill, and dependability.
Please do not list more than one relative as a reference.
1st Preference
2nd Preference
REFERENCE #1:*

First NameLast Name
1. Name:
Email Address:*
E-mail:
How do you know this person? *
REFERENCE #2:

First NameLast Name
Reference # 2:
Email Address:*
E-mail:
How do you know this person? *
Before submitting the application, please read the following statement carefully and sign below:

"I swear or affirm I provided accurate and complete responses to all information requested herein. I give my consent to CrossBRIDGE to confirm all information provided."
e-Signature:*
Today's Date:

MonthDayYear

Should be Empty:

KidPOWER | YouthPOWER Intern Application