Response

Prefix

First Name

Last Name

Suffix

Address Line 1

Address Line 2

City

State

Zip

Phone

Permanent Address (if different)

Emergency Contact Name

Emergency Phone Number

Is academic credit available for internships?

Schools attended, beginning with your current school

Year in School

Graduation Date

GPA

Major

Advisor Name

Activities/Honors

List specific issues or areas of interests

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

Date of Birth:

Desired Location

District Office

Washington DC Office

District Office and Washington DC Offices

Desired Session(s)

Spring

Summer

Fall

Fall, Spring, Summer

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

Cover Letter:

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Resume:

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