Southface Intern Application
Southface Internship Application Form Type or Print Clearly! 1. Personal Data: Name __________________________________________________________ Social Security # _____________________________________________ Are you a U.S. citizen? ___ Yes ___ No If no: Please give Visa / Residency Status and dates of validity ________________________________________________________________ Permanent Address ________________________________________________________________ ________________________________________________________________ Home Phone #____________________________________________________ Work Phone#_____________________________________________________ E-mail:_________________________________________________________ Driver’s License # _______________________________ State ______ Contact in case of emergency: Name ___________________________________________________________ Home Phone # ___________________________________________________ Work Phone # ___________________________________________________ Do you require any particular accommodations due to a disability? ___Yes ___No Please explain _________________________________________________ 2. Education (include your resume): Name & Location of Colleges GPA Major Date Degree Obtained or Universities Attended _____________________________/______/____________/_______________ _____________________________/______/____________/_______________ _____________________________/______/____________/_______________ _____________________________/______/____________/_______________ _____________________________/______/____________/_______________ _____________________________/______/____________/_______________ Do you intend to receive academic credit for this internship? ___ Yes ___ No If yes, please provide the following information about your advisor: Name ____________________________________________________________ Address/Dept.____________________________________________________ College _________________________________________________________ Phone #__________________________________________________________ E-mail __________________________________________________________ 3. Brief Employment History: Employer Position From To ___________________________________/______________/_____________ ___________________________________/______________/_____________ ___________________________________/______________/_____________ ___________________________________/______________/_____________ __________________________________ /______________/______________ References (include phone and e-mail): 1. Name _________________________________________________________ Title & Organization_____________________________________________ _________________________________________________________________ Address _________________________________________________________ _________________________________________________________________ Phone____________________________________________________________ Email____________________________________________________________ 2. Name _________________________________________________________ Title & Organization_____________________________________________ _________________________________________________________________ Address _________________________________________________________ _________________________________________________________________ Phone____________________________________________________________ Email____________________________________________________________ 3. Name _________________________________________________________ Title & Organization_____________________________________________ _________________________________________________________________ Address _________________________________________________________ _________________________________________________________________ Phone____________________________________________________________ Email____________________________________________________________ 4. Internship Information: Please indicate dates of availability (6 months minimum) ____________________________________________________________ Will you need housing? ___ Yes ___ No If you are not selected for an internship during your dates of availability, would you like to remain on file? ___Yes ___No. We will contact you if new opportunities arise. 5. Statement of Intent: In an short essay please provide further information about yourself. Some things that we would like to know are: · Why are you interested in an internship at Southface? · How would your personal abilities, interests, experiences, and course work be useful in an internship? · What would you like to get out of your internship? Please sign and date this form and return it to us as soon as possible, including all requested additional information! Due to the large volume of applications we receive, it is not always possible to contact applicants who are not initially accepted. But we encourage you to contact us about your application! Finally, check our web site, www.southface.org, for more information on who we are and what we do! Signed _________________________ Date _____/_____/_____ Send application and inquiries to: Internship Coordinator Southface Energy Institute 241 Pine Street Atlanta, GA 30308 404-872-3549
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