Internship online application form Internship application form First Name*Last Name*Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What position are you applying for?*-- Choose One --Undergraduate internshipGraduate internshipAssessment practicumHow did you hear about us?*Website searchSocial Media (Facebook, Linkedin, Twitter, etc...)Email/e-newsletterPersonal ReferralHandshakeOtherIf personal referral, who?If other, how?Are you 18 years or older?* Yes No Please tell us why you are interested in interning at MAC.*What are some of your areas of interest for school and future career?*List three (3) of your strengths.*List two (2) areas you would like to grow in.*What are you hoping to get to learn from this internship experience?*If you are interning for school, please provide your school and professor's name and contact information.Do you have experience working with individuals with special needs?* Yes No If yes, please indicate the approximate total hours you have accumulated working with this population.Please list any previous relevant internships, employment or volunteer locations.Please indicate any languages in which you are fluent.Please indicate your availability (shifts are 8:30am - 4:30pm) on the following days. Please check all that apply.* Monday Tuesday Wednesday Thursday Friday Are you able to pass a Department of Human Services criminal background check?* Yes No Emergency contact information*NameRelationshipPhone number Upload resume*Accepted file types: doc, docx, pdf.doc, docx and pdf files accepted.Application certification*By clicking "yes" you certify that, to the best of your knowledge and belief, all of the information on this application and resume is true, correct, complete and made in good faith. I understand that false or fraudulent information on this application or resume, given during an interview, or at any other time during the internship process constitutes sufficient grounds for disqualification from further consideration of the internship program. In consideration of my internship, I will agree to abide by all practices and policies of the Minnesota Autism Center. Yes, I agree. Upload additional supporting documents Drop files here or Accepted file types: doc, docx, pdf.