Internship Application
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First Name *
Last Name *
Are you fluent in Spanish?
 *
Phone Number *
Email Address *
Street Address *
City *
Zip Code *
County *
Which College or University do you attend? *
Which degree are you pursuing? *
If you are employed, who is your current employer and what is your job title?
Describe any previous work or volunteer experience that you have had.
How did you hear about NAMI KDK? *
Are you a NAMI KDK member? *
Are you willing to become a NAMI member? *
What is your relationship to mental illness? *
Required
Do you have any limitations or need any special accommodations?
What is your availability? *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
How many hours do you need to complete for your internship? *
Is this internship voluntary or mandatory for your degree? *
Is there a required length for your internship? *
How many hours do you plan to work per week? (minimum of 10) *
If you selected "other" for the previous question, how many hours do you plan to work each week?
When would you want to start your internship? *
What are your areas of interest? (mark all that apply) *
Required
Tell us about your talents or skills, what do you feel you are good at? *
Professional Reference Name and Phone Number
Academic Reference Name and Phone Number
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