LIFE LEARNING CENTER INTERNSHIP APPLICATION
All individuals interested in an internship/practicum placement with Life Learning Center
must complete this application in full.
Items marked with an asterisk require a response.
Applicant Information:
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail Address
*
example@example.com
Emergency Contact Information:
Emergency Contact Name
*
First Name
Last Name
Relation to Emergency Contact:
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Internship/Practicum Information:
University/Educational Institution:
*
University/Educational Institution Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Major/Area of Study:
*
Degree Expected:
*
Associate's
Bachelor's
Master's
Current GPA:
*
Advisor/Field Instructor Name:
*
Advisor/Field Instructor Phone Number
*
-
Area Code
Phone Number
Advisor/Field Instructor E-mail Address
*
example@example.com
Internship Field of Study Requested
*
Business/Administration
Criminal Justice
Human Services
Marketing
Social Work
How many hours are required for your internship/practicum?
*
Anticipated Start Date of Internship/Practicum:
*
-
Month
-
Day
Year
Date
Anticipated End Date of Internship/Practicum:
*
-
Month
-
Day
Year
Date
What is your availability or desired days/times to work? Hours of operation are listed in the table below.
*
Start Time
End Time
Monday: 8:00am-5:00pm
Tuesday: 8:00am-8:00pm
Wednesday: 8:00am-8:00pm
Thursday: 8:00am-8:00pm
Friday: 8:00am-4:00pm
Saturday: 9:00am-4:00pm
Professional/Volunteer Experience:
Current or Most Recent Employer:
Job Title:
Start Date:
-
Month
-
Day
Year
Date
End Date:
-
Month
-
Day
Year
Date
Short Description of Duties:
Short Essay Questions:
Describe your knowledge of the Life Learning Center and the services we offer. What interests you most about an internship/practicum with the agency?
*
Describe your career goals and why you would benefit from an internship/practicum with the Life Learning Center:
*
BY TYPING YOUR NAME IN THE BOX BELOW, YOU CERTIFY THAT ALL OF THE INFORMATION THAT YOU HAVE PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT.
*
Thank you for taking time to complete the Life Learning Center Internship Application!
We will be in touch shortly.
If you have any questions, please contact Laurie Hoppenjans at: lhoppenjans@lifelearningcenter.us
www.lifelearningcenter.us
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