Internship Application Subscribe First Name:Middle Name:Last Name:Street Address:State:Phone Number:City:Zip:Email Address:Name and location of school where currently enrolled:Course of Study:What program are you interested in for internship?Why would you like to intern for this program?How did you hear about this program?When are you available?Have you ever interned, observed, or had any experience with the court system? Yes NoIf so, please explain:Do you have any relatives who work for the court system? Yes NoIf so, please list:Have you ever been convicted of or had a withhold of conviction for a Misdemeanor or a Felony? Yes NoIf yes, when and what charge?Educational ReferenceThis reference should be from a current teacher, professor, academic advisor, or school administrator who is familiar with your academic performance.Name:Address:Email:Phone Number:Community ReferenceThis reference should be over 21 years of age and should not be a relative. Ideal references include mentors, supervisors, coaches, community leaders, or individuals who can speak to your character, work ethic, leadership abilities, or involvement in community activities.Name:Address:Email:Phone Number:Emergency Contact InformationThis information will only be used in the event of an emergency to contact someone on your behalf. Please ensure the phone number provided is current and reachable.Name of emergency contact:Relationship to Intern:Phone Number: By checking this box, I certify that the information provided in this application is true and correct to the best of my knowledge. I understand that a background check must be completed prior to becoming a volunteer and that completion of this application does not guarantee my becoming a volunteer with the 19th Judicial Circuit.Intern Name:Date:Is the intern under 18 years old? Yes No As the parent/guardian of the applicant, I certify that the information provided is accurate, and I agree to the terms and conditions stated above.Parent/Guardian Name:Date:Submit Form
