Intern with Us Application

Last Name *

First Name *

Street Address

City :

State :

Zip :

Email Address *

Phone (Home) *

Phone (Work) *

Phone (Cell)

Date of Birth
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Please give us the approximate dates when you will be available.

What attracts you to serve at ICC? *

Please comment on your special abilities, talents, educational training and past experiences which could be helpful for your intern placement.
Examples: administrative, writing, web, or professional training.*

What Date Will You Graduate?

Please post your resume/work history.
High SchoolSome CollegeUndergrad DegreeMastersPhD

Please provide us with the full contact info for 3 references :

Please evaluate yourself on the following (5 being stronger and 1 being weaker):

Leadership (enabling of others) *
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Energy level/physical stamina *
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Self-initiation (can you work with little supervision?) *
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Sense of responsibility *
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Cooperative (can work well in a team situation) *
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Flexibility
(can adjust to changes) *
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