Summer Internship Application

First Name *

Last Name *

Date of Birth: *

Preferred Pronouns

Address

City

Zipcode

Phone Number *

Email *

College/University

Major/Degree and Graduation Date

High School and Graduation Date

Are you legally eligible to work in the United States during the internship term? *

Yes
I will require a visa

Languages (indicate fluency using r=reading, w=writing and s=speaking):

How did you learn about this program? (check all that apply)

Website
Visit to the Art Base
Social Media
School
Art Base Staff
Other

Please specify if other:

Please share your thoughts about the following questions. Please limit your response to 300 words or less.

1. Why are you interested in participating in an internship at the Art Base? *

2. What would you hope to achieve by participating in an Art Base internship? *

Please list two references:

Name 1: *

Phone and Email 1: *

Relationship to you 1: *

Name 2: *

Phone and Email 2: *

Relationship to you 2: *

Parents or guardian's contact information:

P/G First Name: *

P/G Last Name: *

P/G Address: *

P/G Email: *

P/G Phone Number: *

Date:

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