Response

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Phone

Permanent Address (if different)

Emergency Contact

Emergency Contact Phone Number

Is academic credit available for internships?

Schools attended, beginning with your current school:

Year in School

Graduation Date

GPA

Major

Advisor

Activities/Honors

List specific issues or areas of interest to you:

Have you served a prior internship in Washington D.C. or in a district office? If yes, with whom?

Date of Birth

Desired Location(s):

Desired Session(s):

Career Objectives

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:

Please attach Cover Letter

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Please attach Resume

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