INTERN & VOLUNTEER APPLICATION FORM Email Address * Indicate the program you are applying for: * Internship ProgramVolunteering ProgramOther Resume * First & Last Name: * Date of Birth: (mm/dd/yyyy): * Address ( City, State, Apt & Zip Code): * Phone Number Cell Phone * Highest Level of Education * Current Grade Level * Name of School ( District & Type [Public or Private] * School Address ( City, State & ZipCode) Skills & Interests Indicate the languages you speak and the level of proficiency Language (1) * Level Of Proficiency * BasicIntermediateAdvancedNativeOther Language (2) * Level Of Proficiency * BasicIntermediateAdvancedNativeOther Please indicate areas of interest (You may check more than one) * Leaders of the FutureCaterpillar Homework ClubGuitarGirl ScoutsAdministrative AssistantMarketing AssistantSecretarySocial Work AssistantCommunity Health Worker If interested in the Caterpillar Homework Club Program, please indicate the subjects you are proficient in * MathHistoryLanguage ArtsSocial StudiesReligionBiologyChemistryESLOther **Please note these subjects include all levels beginning from 2nd to 8th grade. If only proficient in specific grade levels, please indicate ** AVAILABILITY: Please indicate your availability. Note: This availability will be maintained throughout your time at Niño de la Caridad. DAYS * MondayTuesdayWednesdayThursdayFriday HOURS( ie: Mondays 9-6pm, Tuesdays 11-7 pm ) * Please indicate the commitment you are able to make to NIÑO DE LA CARIDAD, INC. * Fall SemesterWinter SemesterSpring SemesterSummer1 yearMore than 1 yearOther Please complete below if volunteer is 18 years or younger Parent/Guardian (1) First & Last Name: Adddress(Apt, City, State & Zipcode) Home Phone: Cell Phone: Email: Emergency Contact First & Last Name: Adddress(Apt, City, State & Zipcode) Home Phone: Relationship to Student Parent/Guardian (2)First & Last Name: Adddress(Apt, City, State & Zipcode) Home Phone: Cell Phone: Emergency Contact (2) First, Middle & Last Name: Adddress(Apt, City, State & Zipcode) Home Phone: Relationship to Student For High School Students ONLY Please indicate a 75-word description of why do you would like to participate in the foundation. * HS students ONLY: Attach High School transcript. [NDCL requires all HS volunteers to maintain an overall 3.0 GPA (80% or B)] *
