CHOICE, unlimited
1829 E. Superior St.
Duluth MN 55812 
V (218) 724-5869 
TTY (218) 724-3546 
Fax (218) 724-0359

INTERNSHIP APPLICATION
							
                                                                                            
Date:
Name:
Day phone:
Address:
Eve. Phone:
City:
State:
Zip:

Internship for (please choose from the following):  
Undergraduate Requirements   Masters Level Requirements   Other (Please identify)


What University are you currently attending?


What times and days are you available to complete your Internship responsibilites?


How many Internship hours do you need to fulfill?


What goals and experiences do you hope to gain through your Internship experience with CHOICE, unlimited?



Have you ever worked, volunteered, or had an Internship experience with CHOICE, unlimited in the past? 
If so, when and what did you do? 


Please list any special training / skills / interests you possess:


How did you hear about our Internship opportunities?


Emergency Contact and Phone number:


Internship Coordinator Contact information:  (Name, Address, Phone Number, E-mail Address)