Internship Application Applicant's Contact Information Prefix First Name MI Last Name Suffix Address Line 1 Address Line 2 City State Alabama Alaska America Samoa Arizona Arkansas California Colorado Connecticut D.C. D.C. Delaware Federated States of Micronesia Florida Foreign Correspondence Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Email Phone Applicant's Additional Information Date of Birth: Where would you like to work (Check all that apply): District OfficeWashington DC Office Desired semester(s) for internship: SummerSpringFall Internship Start Date: Internship End Date: Permanent Address (If different) Emergency Contact Information Emergency Contact Name: Phone Number: Additional Relevant Information List specific issues and areas of interest to you: Have you served a prior internship in Washington D.C. or in a district office? If yes, with whom?: Schools attended, beginning with your current school: If you are currently enrolled in College/University. Is academic credit available for internships?: Yes No Year in School: Graduation Date: GPA: Major: Activities/Honors: Career Objectives: Advisor's Name: Names and Addresses of Three References: Please use this box to write a brief paragraph about yourself, including the reasons why you would like to intern in a congressional office.
Internship Application
Applicant's Contact Information
Applicant's Additional Information
Permanent Address (If different)
Emergency Contact Information
Additional Relevant Information