POSITIVE MEDIA INTERNSHIP

Internship Application (All fields are required)

CONTACT INFORMATION

Full Name

Street, Address*
Include city and state

State Zip Code

E-mail

Phone number

Alternate phone

Emergency Contact

Relationship

Birthdate

Are you active on Facebook? If so, please accept our friend request from Positive Media Interns

yes no

Marital Status:

single married divorced

Do you have children?

yes no

PROFESSIONAL INFORMATION

Highest level of education completed. Please check all that apply

High School

College

Graduate School

Major

Degree

Work history. Please describe your past 5 year work history

Please select areas in which you have proficiency:

Tele-Marketing
Project Management
Sales
Acting
Public Speaking
Graphics
Video Editing
Administrative Support
Databasing

How fast do you type? words per minute

Please select the Program for which you are applying

A	Headquarters Full Program Fall Semester: September – December	If you need dates to be modified indicate here:
B	Headquarters Part-time Program Fall Semester: September – December	For the part time program you must commit to a minimum of 8-20 hours per week. Please indicate which days and hours you are available:
C	Headquarters Full Program Winter Semester: January – Mid May	If you need dates to be modified indicate here:
D	Headquarters Part-time Program Winter Semester: January – Mid May	For the part time program you must commit to a minimum of 8-20 hours per week. Please indicate which days and hours you are available:
E	Headquarters Full Program Summer Semester: July and August	If you need dates to be modified indicate here:
F	Headquarters Part-time Program Summer Semester: July and August	For the part time program you must commit to a minimum of 8-20 hours per week. Please indicate which days and hours you are available:

Foreign Language Skills

Language

Conversational
Fluent
Read and comprehend a college level document
Can compose a professional letter or report

Language

Conversational
Fluent
Read and comprehend a college level document
Can compose a professional letter or report

EXTRACURRICULARS

Personal

Briefly describe your current involvement with other groups, clubs, or associations. Maximum 150 words.

Family

Please describe your relationship with your family. How have they influenced your development? Who has shaped you the most? What kind of support (emotional, spiritual, etc.) do they provide for you?. Maximum 150 words.

Personal Development

Describe a time when you overcame an obstacle that helped form who you currently are. Maximum 150 words.

Is there any feasible reason you would not be able to fully comply with the proposed intern/formation program schedule? See schedule

yes

no If yes, please explain here:

Statement of Faith

Are you comfortable working in a Christian, Catholic, and faith-based environment?

yes

no If yes, please explain here:

Are you an active Christian? If so please describe your spiritual disciplines and why your faith is important to you. Maximum 250 words.

References

List the name, phone number, and email addresses of two references. Ideally one reference from someone in Christian ministry who knows you well, preferably in a mentor or teaching capacity, and the other reference from a work, school, or volunteer supervisor.

Spiritual Reference

Name
Phone
E-mail

Work/Academic Reference

Name
Phone
E-mail

MEDICAL HISTORY

Are you taking any prescription medications?

yes

no If yes, please list here:

Do you have any medical conditions?

yes

no If yes, please list here:

Do you require additional assistance?

yes

no If yes, please explain here:

Have you ever been hospitalized?

yes no If yes, please explain here:

Do you see a psychologist or therapist?

yes no

If so, are they in favor of you applying for this internship?

yes no

_______________________________________________________________________________________

All fields are required

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