CRC Rehabilitation Internship Application
Thank you for your interest in Carolina Raptor Center's Rehabilitation Internship
Program. All internship positions at CRC are unpaid. Applicants must provide their own
housing and transportation. Currently CRC charges a one-time nominal fee of $20.00 for
a t-shirt and a permanent nametag to be worn while representing CRC.
Please note that all interns are required to have a current tetanus shot.
Please complete the form below and return by mail or email. Due to our heavy case
load, and the time that it takes for references to respond to our enquiries, we may not
be able to contact you immediately. If 14 days have passed since you sent your
application and you have not heard from us, you may check on it then.
Personal Information:
Name:
Address:
City:
Email:
Date of birth:
State:
Home Phone:
Work Phone:
Cell Phone:
Zip:
Please note: You must be at least 18 years of age.
Emergency contact information:
Name: ______________________________ Relationship to applicant:_______________
Phone number: ______________________
Education
Circle appropriate items
High School 1 2 3 4
Name of School: ____________________
State: ____
Extracurricular activities:_________________
_____________________________________
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College 1 2 3 4 5+
Name of School: ________________
State: ____
Major:_____________________
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Experience
Please list up to three positions or classes relevant to the internship program for which
you are applying. These can be volunteer or paid. Briefly describe your work
experiences.
1.
2.
3.
References
Please list three references, preferably a combination of work and/or school related
references. These can include, but are not limited to individuals working at any of the
above-mentioned facilities.
1. Name:
Address:
Phone number:
Email address:
Relationship to applicant:
2. Name:
Address:
Phone number:
Email address:
Relationship to applicant:
3. Name:
Address:
Phone number:
Email address:
Relationship to applicant:
Because of the intensive nature of our internships, all interns are required to attend a
special orientation and class at the beginning of their internship. Please note that your
internship will begin immediately after the class you sign up for. Please circle or
otherwise indicate which class you will attend.
January 2, 2011
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May 29, 2011
September 4, 2011
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Below are listed internship schedules. Please indicate in order of preference which shifts
you are available to work, with “1” being your first choice and “4” being the least
preferred. If there are any shifts that you cannot work due to school, job, or other
conflicts, please write “no” beside them. Please note that there will only be one intern
per shift, and that shifts will be assigned on a first-come, first-served basis. Depending
on the time of year and number of other interns, the days/times may be adjustable.
Order of
Preference
Days
Time
Monday, Wednesday, Friday
Monday, Wednesday, Friday
Tuesday, Thursday, Sat
Tuesday, Thursday, Sat
8:00 am – 2:00 pm
2:00 pm – close (around 8:00 pm)
8:00 am – 2:00 pm
2:00 pm – close (around 8:00 pm)
As an intern at CRC, you will work approximately 20 hours per week for 10 weeks, for a
total of 200 hours.
Are you receiving academic credit for this internship? ________
If yes, is there paperwork CRC has to complete? _________
Please include the contact information of the teacher or professor approving the
internship. Include an address where your final evaluation can be mailed or emailed.
Please outline your goals, or things you wish to accomplish during your time as a CRC
intern.
Why have you applied for an internship at Carolina Raptor Center?
What contributions will make you an asset to Carolina Raptor Center?
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11/2010
Do you feel you work best in groups or alone? Explain.
How do you feel that you learn the best? i.e.: through hands-on experience,
observation, reading written material?
Please include a current resume with your application.
There is a one-time fee of $20.00, due four weeks prior to the beginning of your
internship, to cover the cost of a CRC volunteer/intern T-shirt and a permanent name
tag.
Write your name the way you want it to appear on your name tag
Please mail or email the completed form and supporting documents to:
Carolina Raptor Center
Carly Orlando
Rehabilitation Coordinator
P.O. Box 16443
Charlotte, NC 28297
704-875-6521 ext. 213
corlando@carolinaraptorcenter.org
Due to the poor quality of some faxes, we cannot accept faxed applications at this time.
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11/2010