Winter Internship Application
Name
Soc. Sec. Number
Permanent Address
School Address
E-Mail Address
Phone number
University
Length of Internship
Degree Objective
Graduation Date
What volunteer or work experience do you have working with people with disabilities?
Please check the disabilities you have direct working or volunteer experience with:
Developmental disabilities
Spinal Cord Injuries
Visual Impairments
Traumatic Brain Injuries
Hearing Impairments
Cerebral Palsy
Spina Bifida
ADD / ADHD
Mental Health
What experience do you have for summer and/or winter recreation activities? (Please be specific)
What experience do you have in therapeutic recreation?
What is your main interest in applying for our internship program?
(Optional) Do you have a disability?
Yes
No
What accommodations can we provide to assist you?
Please comment on specific content area(s) or disabilities you would like experience with during your internship:
Please tell us about yourself:
Please tell us about the skills you can bring to our program:
Certifications:
Additional Comments:
Contact Information