Indicates required field Your InformationPrefix:- Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Rev.Dr.The HonorableRabbiFirst Name: MI: Last Name: Suffix:- None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and FamilyYour Contact InformationAddressAddressAddress 2CityState- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP CodeEmail:TelephonePhone Number:Phone Type:- None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD]phone textWhat are these options?Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.Permanent Address (if different)Permanent AddressAddressAddress 2CityState- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP Emergency Contact Information:Emergency Contact Name:Emergency Phone Number:Phone Type:- None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD]Academic InformationIs academic credit available for internships?YesNoRelevant if you are currently enrolled in College/University.Schools attended, beginning with your current school:Year in School:Graduation Date:MonthMMJanFebMarAprMayJuneJulyAugSepOctNovDecDayDD01020304050607080910111213141516171819202122232425262728293031YearGPA:Major:Advisor's Name:Activities/Honors:Skills applicable to internshipList specific issues or areas of interest to you:Have you served a prior internship in Washington D.C. or in a district office? If yes, with whom?Applicant's Additional InformationDate of Birth:MonthMMJanFebMarAprMayJuneJulyAugSepOctNovDecDayDD01020304050607080910111213141516171819202122232425262728293031YearDesired Location(s):- Select -District OfficeWashington DC OfficeDistrict Office and Washington DC OfficesDesired Session(s):- Select -FallSpringSummerFall, Spring, SummerCareer Objectives:Names and Addresses of Three References:Please use this box to write a brief paragraph about yourself, including the reasons why you would like to intern in a congressional office:Cover Letter:One file only.1 MB limit.Allowed types: txt, rtf, pdf, doc, docx. Resume:One file only.1 MB limit.Allowed types: txt, rtf, pdf, doc, docx. file textYour file size can not exceed 2MB. Documents must be the following file types: .doc, .docx, .pdf, .rtf, .txtMac users: Your document must have a file extension. Resave it using your word processor with the appropriate extension from the above list. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.