Amicable Internship Program 2022 Personal Information Name * Last, First, MI DOB * Mobile Phone * Home Phone Email * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Education I am applying for the: * Fall Spring Summer What year are you in? * What is your major? * PLEASE IDENTIFY UP TO FIVE SHIFTS WITH A TOTAL OF AT LEAST 20 HOURS/WEEK Enter the time duration for the days you are available to work. Monday From 121234567891011 : 0030 AMPM Monday To 121234567891011 : 0030 AMPM Tuesday From 121234567891011 : 0030 AMPM Tuesday To 121234567891011 : 0030 AMPM Wednesday From 121234567891011 : 0030 AMPM Wednesday To 121234567891011 : 0030 AMPM Thurday From 121234567891011 : 0030 AMPM Thursday To 121234567891011 : 0030 AMPM Friday From 121234567891011 : 0030 AMPM Friday To 121234567891011 : 0030 AMPM Emergency Contact Name * Relationship * Ex. Mother, Aunt, Grandfather, etc Mobile Phone * Home Phone Agreement Student Signature Clear Date Attach Resume Drop a file here or click to upload Choose File Maximum upload size: 516MB If you are human, leave this field blank. Submit