Intern Application for Education & Outreach

Please fill out the form below and email your resume, three professional references, and cover letter to Education@Pelicanharbor.org.

Due to the volume of applications we receive, if your application is incomplete (missing resume or cover letter) it will not be reviewed.

Personal Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Date of Birth

YYYY

Have you ever been convicted of a crime?

Yes

If YES, please explain the charges and circumstances:

How did you hear about this internship?

Medical Information

Emergency Contact Name

First Name

Last Name

Relationship

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number

(###)

###

####

Do you have a current Tetanus shot?

Yes

Do you have current medical insurance?

Yes

Medical Insurance Provider

Do you have any medical conditions or allergies that require special accommodations?

Yes

If YES, explain:

Education Information

Current or most recently attended School:

Dates Attended:

Expected graduation date:

Major:

Extra-curricular activities:

The above information is true and accurate to the best of my knowledge. I understand that falsification of information will be grounds for immediate dismissal.

Please sign by typing your FULL name. (example: Ruddy A. Turnstone)

Todays Date

YYYY