Internship Form

Please complete the form below. The deadline for Summer 2012 internship applications is March 31.

Fields marked with an asterisk (*) are required:

Contact Information

Prefix*:

First Name*:

MI:

Last Name*:

Suffix(Jr., Sr.):

Permanent Home Address:

Address*:

City*:

State*:
KY

Zip*:

Daytime Phone*:

Evening Phone:

E-mail*:

Date of Birth: (MM/DD/YY)

Internship Information

Internship Term*:

Internship Begins*: (MM/DD/YY)

Internship Ends*:
(MM/DD/YY)

Where would you like to work*:

Hours available to work(6am-6pm)*:

Mon.	Tues.	Wed.	Thurs.	Fri.

Education

High School: *		High School City/State:*
Date of Graduation:*	Unweighted GPA:
Weighted GPA (if applicable):


Undergraduate Institution:	Undergraduate City/State:
Date of Graduation:	Major:
Date of Matriculation:	Est. Graduation Date:
GPA:

Graduate Institution:	Degree:
Est. Graduation Date:	GPA:

Additional Information
Have you ever been a resident of the Sixth Congressional District? If so, where have you lived?:

Why do you want an internship with Congressman Ben Chandler?:

How did you become interested in the legislative process, public policy, politics and government?:

Enter your initials.
I have represented myself truthfully on this application and in my application materials.

Send your resume, writing sample and two letters of recommendation to jason.robinson@mail.house.gov.

By mail:
1504 Longworth HOB, Washington DC 20515

Incomplete or late application packets will not be accepted.

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Internship Form

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District Office