Internship Application

Contact Information
First Name*
Middle Name
Last Name*
Alias or Maiden Name
Prefer to be Called
Date of Birth*
Date Format: MM slash DD slash YYYY
Race/Ethnicity
Gender
Pronouns
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
How can we find you on Facebook?
What's your twitter handle?
And what's your instagram account name?

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University / School Affiliation*
Degree Seeking*
- Bachelor's
- Master's
- Doctoral
Projected Graduation Date
Date Format: MM slash DD slash YYYY
Major or Area of Study*
Type of Internship Desired
- Field Study
- Practicum
- Internship
- Other
Total Number of Internship Hours Needed*
Ideal Start Date*
Date Format: MM slash DD slash YYYY
Ideal Completion Date*
Date Format: MM slash DD slash YYYY
Required Internship Completion Date
Date Format: MM slash DD slash YYYY
Date Practicum Site must be submitted to your school
Date Format: MM slash DD slash YYYY
Supervision Requirements / Supervisor Certifications Required*

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We have to ask...
Have you ever been convicted of or arrested for a criminal offense, other than a minor traffic violation?*
- Yes
- No
If you have been arrested for or convicted of a criminal offense, please describe the type of offense, date, law enforcement agency, and current status.
Do you have access to a working vehicle?
- Yes
- No
Do you have car insurance?
- Yes
- No
Do you have a valid driver's license?
- Yes
- No

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Schedule Preference
Palomar’s hours of operations are Monday-Friday 8-5. We occasionally have events on evenings and weekends.
Days of the week you prefer to volunteer*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Time of day you prefer to volunteer*
- Mornings
- Afternoons
How did you learn about Palomar?*
Please describe why you want to intern at Palomar: Oklahoma City's Family Justice Center.*

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Consent*
- By checking this box, I hereby certify that all statements made in this application are true, and I understand that any false statement of material facts herein may cause forfeiture on my part of all rights to volunteer at Palomar: Oklahoma City's Family Justice Center. I understand that if selected, I will be required to consent to a full background check through the Oklahoma State Bureau of Investigation.
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Contact Information