Sustainable Directions Internship Program Student Application Deadline: April 4, 2008

Triskeles Foundation
Sustainable Directions Internship Program

Student Application
Deadline: April 4, 2008
Contact Information
Name: _____________________________________________________ Age:

______________________
Home Phone: _________________________________ Cell Phone:
______________________________
Email address:
_________________________________________________________________________
Address: (Street, Apt. #):
_________________________________________________________________
City: _________________________ State: __________________________ Zip:
_____________________
SSN: _________- ________ -- __________________ Date of Birth:
_____________________________
Name of Parent or Guardian: ___________________________________Relationship:
_______________
Current Grade: □9 □ 10 □ 11 □ 12 Expected Graduation Date:
_______________________
School Name:
__________________________________________________________________________
Teacher/Advisor:
_______________________________________________________________________
Student Profile
Total number of days absent this year: ________ Total number of tardies this
year: _________
Extracurricular activities (sports, drama, clubs, etc.):
Community or volunteer activities:
Sustainable Directions Internship Program Student Application 1

Special skills or talents you possess and/or machines and equipment you can
use:
Are there any languages you use fluently in addition to English? List them below.
Listen & Speak:
________________________________________________________________________
Read: ______________________________________Write:
_____________________________________
Employment History
List most recent employer first. Include volunteer work and internships. (You
may attach resume)
1. Name of employer: ________________________________________ Phone:

____________________
Address:
______________________________________________________________________________
Immediate supervisor:
___________________________________________________________________
Position/Title:
__________________________________________________________________________
Tasks/type of work:
_____________________________________________________________________
Date first employed (month/day/year): _____/_____/________ Date left:
_____/_____/________
Reason for leaving:
______________________________________________________________________

____________________
Address:
______________________________________________________________________________
___________________________________________________________________
Position/Title:
__________________________________________________________________________
Tasks/type of work:
_____________________________________________________________________

_____/_____/________
Reason for leaving:
______________________________________________________________________

____________________
Address:
______________________________________________________________________________
___________________________________________________________________
Position/Title:
__________________________________________________________________________
Tasks/type of work:
_____________________________________________________________________
_____/_____/________
Reason for leaving:
______________________________________________________________________
Do you know how to type? □ yes □ no Words per minute:

________________
Your computer experience: □ expert □ some □ very little □
none
Nature of experience (classes taken, operating systems and software programs
you can use):
Is there anything else you would like to tell us about your employment history?

Professional References
Please provide the names and contact information of at least 2 professional references.
These should be former employers or supervisors, teachers or school administrators and
should not be people who are related to you or in your peer group. Remember to ask first
before listing someone as a reference.
First Reference
Name: __________________________________ Email:
_______________________________________________
Work Phone: _____________________________ Alternate phone:

______________________________________
How long have you known this person? __________________
How do you know this person? How does this person know you?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Second Reference
Name: __________________________________ Email:
_______________________________________________

______________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Third Reference (optional)

Name: __________________________________ Email:
_______________________________________________

______________________________________

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Student Reflection
Please answer the following questions completely. This is an opportunity to
display your written communication skills, so use complete sentences. You are
encouraged to type your responses and attach a separate sheet.
1. Why are you interested in this internship program? Why are you interested in
working for a socially progressive business, organization or agency?
2. What do you expect to gain from this internship?
3. What is the one accomplishment of which you are most proud?
4. List three things you do well right now.


5. List three things you would like to learn to do better.


6. What is your favorite academic subject? Why?
7. Grade point average last semester: __________. Why do you believe you
earned this GPA?

8. Describe yourself in three words.

9. Do you prefer to work alone or in a team? Why?
10. What goals have you set for yourself?
11. What careers are you interested in?
12. On a scale of 1-10, rate the importance of the following items. A rating of 1
means not very important, a 10 means very important.
a. Your education _____
b. A career _____
c. A job _____
d. Owning your own home _____
e. Owning your own car _____
f. How your friends see you _____
g. How your family sees you _____
h. Your hobbies _____
i. Having a mentor _____
13. Pick one of the above items, and write a short essay to explain the rating
you gave it (use a separate piece of paper).


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Triskeles Foundation

Sustainable Directions Internship Program

Name: _____________________________________________________ Age:

Extracurricular activities (sports, drama, clubs, etc.):

Community or volunteer activities:

Sustainable Directions Internship Program Student Application 1

1. Name of employer: ________________________________________ Phone:

2. Name of employer: ________________________________________ Phone:

Sustainable Directions Internship Program Student Application 2

3. Name of employer: ________________________________________ Phone:

Do you know how to type? □ yes □ no Words per minute:

Sustainable Directions Internship Program Student Application 3

Work Phone: _____________________________ Alternate phone:

How long have you known this person? __________________

Work Phone: _____________________________ Alternate phone:

How long have you known this person? __________________

Third Reference (optional)

Work Phone: _____________________________ Alternate phone:

Sustainable Directions Internship Program Student Application 4

Sustainable Directions Internship Program Student Application 5

2. What do you expect to gain from this internship?

3. What is the one accomplishment of which you are most proud?

4. List three things you do well right now.

5. List three things you would like to learn to do better.

6. What is your favorite academic subject? Why?

Sustainable Directions Internship Program Student Application 6

9. Do you prefer to work alone or in a team? Why?

10. What goals have you set for yourself?

11. What careers are you interested in?

Sustainable Directions Internship Program Student Application 7

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