1

Student Contact Information:

 *

Student Contact Information:

Student Name	Phone numberext.
Email	Preferred pronouns

2

Are you or will you be enrolled in an internship course?

*To be eligible for a CARE 7 internship, students must be or will be enrolled in an internship course.  

Are you or will you be enrolled in an internship course? *To be eligible for a CARE 7 internship, students must be or will be enrolled in an internship course.

Yes

No

3

Student Status

Student Status

Campus Based

Online

4

School, Course and Degree Information 

 *

School (i.e. ASU, GCU)	Course number
Degree

5

Start and End Dates for Internship:

 *

Start and End Dates for Internship:

Start Date:

End Date:

6

Have you ever been arrested or convicted of a crime, including any conviction that was later set aside or expunged?

Have you ever been arrested or convicted of a crime, including any conviction that was later set aside or expunged?

Yes

No

If yes, please explain where, when, and disposition:

Please list and explain any other names you have used, if applicable:

7

Area of interest (check all that apply).
Learn more about CARE 7 programs here. 

Area of interest (check all that apply). Learn more about CARE 7 programs here.

CARE 7 Crisis Response Van

Case Management/Veteran Services (requires office hour availability)

Victim Services (requires office hour availability)

8

Availability:

Availability:

	Daytime (8a-4p)	Evening (4p-12a) Only applies to CARE 7 Crisis Response	Overnight (11p-8a) Only applies to CARE 7 Crisis Response
Sunday	Availability:	Availability:	Availability:
Monday	Availability:	Availability:	Availability:
Tuesday	Availability:	Availability:	Availability:
Wednesday	Availability:	Availability:	Availability:
Thursday	Availability:	Availability:	Availability:
Friday	Availability:	Availability:	Availability:
Saturday	Availability:	Availability:	Availability:

9

Please upload your resume.

 *

Please upload your resume. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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