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Therapeutic Intership Application

THERAPEUTIC RECREATION INTERNSHIP APPLICATION
THE ROCKY MOUNTAIN MS CENTER
KING ADULT DAY ENRICHMENT PROGRAM

Please fill out the form below and submit it. You will be contacted once your application form is received.

* = required fields
Your Information
Date: *   MM / DD / YYYY
First Name: *  
Middle:  
Last Name: *  
Birthdate (optional):  MM / DD / YYYY
Social Security #:  

Your School Address
Address: *  
City: *  
State: *  
Zip: *  
Email: *  
Phone: *  

Your Permanent Address
Address: *  
City: *  
State: *  
Zip: *  
Email: *  
Phone: *  

Education
Name of College/University: *  
Name of College/University Advisor: *  
Title: *  
Address: *  
City: *  
State: *  
Zip: *  
Email: *  
Phone: *  

Major: *  
When do you expect to graduate? *  
Will you have access to a vehicle? (car, truck, motorcycle)? *  
If yes, what type? *  
Length of internship required by the College/University - (KADEP requires 15 weeks): *  
Preferred start date: *   MM / YYYY
Preferred ending date: *   MM / YYYY
Did you read and understand internship information and dates? *  
Please summarize briefly your work/volunteer experience with individuals with disabilities.  

Employment History
Employer One
Employer Name:  
Address (included City and State):  
Phone:  
Start Date: MM / DD / YYYY  
End Date: MM / DD / YYYY  
Brief description of duties:  
Employer Two
Employer Name:  
Address (included City and State):  
Phone:  
Start Date: MM / DD / YYYY  
End Date: MM / DD / YYYY  
Brief description of duties:  
Employer Three
Employer Name:  
Address (included City and State):  
Phone:  
Start Date: MM / DD / YYYY  
End Date: MM / DD / YYYY  
Brief description of duties:  
Employer Four
Employer Name:  
Address (included City and State):  
Phone:  
Start Date: MM / DD / YYYY  
End Date: MM / DD / YYYY  
Brief description of duties:  

Your Goals
What do you expect from an internship experience?  
List your goals for your internship experience:  
Provide a statement of your career objective:  
Are you available for a personal interview?  
If so, when?  
How did you hear about the King Adult Day Enrichment Program?  
Please note - your application to the internship program is not complete until you have also submitted your resume with cover letter, a copy of your transcripts and a letter of recommendation from your advisor.

Upload your resume and cover letter - Coming soon.

If you want to submit these at another time by fax, mail or email, just click the "Submit your application" button below.