POLICIES
Before completing and submitting the Student Internship Application, please read the following Integrity House policies.
• 1.90: Student Intern Policy
• 1.93: Code of Ethics Policy
• 1.52: Confidentiality Procedures & Requirements Policy

FORMS
• Fingerprinting

CONTACT
If you have any questions, please contact ewgibson@integrityhouse.org.

Student Internship Application

"*" indicates required fields

Step 1 of 5

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

School Email*

School Name*

Major*

Internship Start Date*

Internship End Date*

Credentials Required by Intern Supervisor*

Please list any and all credentials required by your on-site supervisor at Integrity House to meet your program's prerequisites. Please list NA if this is not a requirement of your program.

Weekly Hours Required*

Total Hours Required (Per Term)*

School Field Office Contact Name*

First Last

School Field Office Contact Email*

Availability*

Please list the days and times you are available. For example, Mondays from 9am to 3pm, Wednesdays from 2pm to 5pm, etc.

Experience*

Describe any student organizations, job experiences, additional coursework (undergraduate and graduate), skills, degrees, certifications, or licenses that you have that will help you with this internship.

Career Goals*

Describe your career goals and how this internship will help you reach those goals. Be specific about the experiences you want to gain through this internship and why you believe this internship can provide such an experience.

Current Academic Status*

Are any of your relatives or friends employed by Integrity House?*

Name*

First Last

Site Preference*

Students placement location will be determined by Integrity House's needs, but the organization will aim to accommodate location preference. Please list any of the following sites in order of preference: Newark, Secaucus, Morris Plains, Toms River, Kearny (Corrections).

Please upload your resume.*

Drop files here or

Accepted file types: doc, pdf, Max. file size: 50 MB.

Did you attend high school?*

High School Name*

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

End Date*

Degree*

Did you attend a trade school?*

Trade School Name*

Address*

Street Address Address Line 2 City State ZIP Code

Start Date

End Date*

Certificate*

Did you attend an undergraduate university or college?*

Status*

I am currently enrolled in a program.

I have graduated from a program.

University Name*

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

End Date*

If you are still enrolled, what is your anticipated completion date?

Degree*

Did you attend graduate school?*

Program Status*

I am currently enrolled in a program.

I have completed a program.

Graduate School Name*

Address*

Street Address Address Line 2 City State ZIP Code

Start Date*

End Date*

If you are still enrolled, what is your anticipated completion date?

Degree*

Primary Emergency Contact Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Secondary Emergency Contact Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship*

Student Internships: Policies, Forms & Application

Student Internship Application

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