Kaity's Way Intern Application
Our Policy - It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.
Personal & Contact Information
Last Name *
First Name *
Middle Name or Initial
Street Address *
City, State, Zip Code *
Cell Phone Number *
Alternate Phone Number
E-Mail Address *
Date of Birth *
Do you have reliable Transportation? *
Let us know when you are available to do your internship hours. The expectation is you will be available the days and times you indicate for us to schedule you for events and such. For example: you have class on Tuesdays until noon, but can be available in the afternoon to complete hours. Select Tuesday in the next question and in the following question you would put your time frame reasonably as 2pm to 6pm. Allowing yourself time for travel and possibly lunch.
During which days of the week are you available for assignments? *
Check all that apply
What time frame of each day are your available? *
Please list each day of availability and the times you are available
High School/College Course Details
We want to know a few things about your intern course at your school.
What High School or College are you attending? *
Semester *
Select the semester of your course
When does your semester begin and end? *
What is the name of the course your taking for this Internship? *
What Level Course is this *
Is this a Capstone project Internship? *
Is this an online course? *
What is your Instructors Name? *
What is your area of Study? *
What is your target Graduation date? *
Are you taking any other Classes in addition to your internship class? *
If you are taking other classes besides the internship course, are they A & B Session Classes? *
Are you able to provide Kaity's Way a copy of your Schedule for the semester of your internship? *
Internship Details
How many Intern hours do you need for this semester to complete the course? *
What area(s) of the Valley would you prefer to Intern? *
Check all that apply
Area of interest for Interning *
Check all that apply
Tell us about any special skills or qualifications you have *
Tell us about any previous Intern or Volunteer Experience you have *
Miscellaneous Information
Person to notify in case of emergency *
Please provide their name and contact information (phone number, email address)
Parent/Guardian Contact Information
If you are under the age of 18 please provide your parent/guardians contact information phone number and/or email address for verification
Agreement & Signature
By submitting this application, I affirm that the facts set forth in it are true and complete to the best of my ability. I understand that if I am accepted as an Intern, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

In addition, I understand the act of submitting this application will constitute my signature of this application.

I further agree that Kaity's Way may use any image, photograph, voice or likeness, in its promotional materials and publicity efforts without payment or other consideration. I understand that these photographs, images, video or audio may be retouched or enhanced that may further be used in publications, print ads, electronic media (e.g., video, CD-ROM, Internet/WWW), or other media now known or hereafter created, anywhere in the world. I further understand that by participating in the photography or filming, I release Kaity's Way an its representatives, employees, board members, licensees, photographers, and their designees from any and all liability for any violation of any privacy or proprietary rights.
Signature *
Enter your full name
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