Current Personal Information References Acknowledgements PREA Standards Complete If you would like to be considered for this position, you will need to complete and return the attached release. This release requires personal identification information. You can return the completed form in one of the following ways:By email to [email protected] (please encrypt),By secured fax to (325) 658-6346, orIn person at 3036 N Bryant Blvd, San Angelo, TX 76903 Name Telephone Email Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Seeking this internship for: Name of college in which you are currently enrolled Current academic standing Major Total number of internship hours you are requesting Hours per week List days of week and times you will be available to work Do you plan to work while enrolled in the internship program? Name of employer Your position Volunteer experience Have you ever been convicted of a felony or subjected to a deferred adjudication on a felony charge? Yes No Do you speak a language other than English (if required for this position?) Yes No Goals & Expectations View PDF of Page
