Internship Application Name * First Name Last Name Preferred Nickname Date of Birth * MM DD YYYY Sex * Male Female Email Address * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Main Phone * (###) ### #### Alternate Phone (###) ### #### Medical Insurance * Policy Number Occupation Name of Employer/School Education Level * Highest level completed High School Undergraduate Graduate PhD Subject of Higher Education Expected Date of Graduation Special Skills * Describe any camp skills you have Do you have a current Red Cross (or equivalent) Lifeguard Certification? Yes No CPR? Yes No Wilderness First Aid? Yes No EMT? Yes No RN/LPN? Yes No Any other certifications pertaining to camp? Do you have a valid driver's license? * Yes No Would you have transportation for the whole camp season at our location in Southwest Virginia? Volunteer or Paid Experience * Please describe any related paid or volunteer experience, including name and description of position, time held, and rate of pay (if any). Subjects of Interest * In the following list, please check each box before those activities you have experience with and can assist with or teach as an expert. Archaeology Birding Fly Fishing Aquatic Insects Wildflowers Salamanders Moths Pollinators Insects Mushrooms Butterflies Cultural History Wild Harvesting Astronomy Art Natural History Hiking Snorkeling Geology Photography Camping Other NOTE * By submitting this application, you are indicating that you are willing to submit to a criminal background and sex offender registry check prior to beginning your internship. You may be asked to provide further identifying information and personal references as part of this process. If you understand and agree to the above statement, please check this box: I agree Thank you for your interest in the Blue Ridge Discovery Center’s Internship Program. Our internship coordinator will contact you after receipt of this application.
