Emergency Contact

Apply for a Komen Internship For information about Internships at Komen for the Cure, please review our Internship Overview. * = Required field First Name*:   Last Name*:   Address*:   City*:   State*:  -Select State- Alabama Alaska Arizona Arkansas 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   Zip Code*:   Home Phone*: - - Other Phone: - - Work Mobile Fax: - - Email*:
If out of state, will you have accommodations and transportation in the Dallas area?		Yes No

First Name:
Last Name:
Phone:
Relationship:

A. Education

University/College*:
Undergraduate Graduate
Field of Study*:
Internship Coordinator
First Name:
Last Name:
Title:
Telephone:
Email:

B. Current Occupation / Volunteer Experience*

Please indicate your current occupation or volunteer experience:(Max 1200 characters)

Hobbies and Interests*

Please list any hobbies or interests:(Max 1200 characters)

Special Skills*

Please list any special skills you have, such as language, public speaking, media, fundraising, etc.:(Max 1200 characters)

E. Academic References

Reference 1:
First Name*:
Last Name*:
Address*:
City*:
State*:	-Select State- Alabama Alaska Arizona Arkansas 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
Zip Code*:
Telephone*:	- -
Reference 2:
First Name*:
Last Name*:
Address*:
City*:
State*:	-Select State- Alabama Alaska Arizona Arkansas 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
Zip Code*:
Telephone*:	- -

F. Internship Interest*

Explain BRIEFLY why you are interested in an internship with the Komen for the Cure:(Max 1200 characters.)

Which area(s) interest you? (Please note: Availability and timeframes vary)

Cause Related Marketing (CRM) and Fundraising Programs Communications Development Domestic Affiliate Network (including, Affiliate Service, Affiliate Finance and Race for the Cure) Health Sciences (including, Health Education, Community Health, Grants) Office of the President Public Policy Strategic Planning

G. Internship Timeframe Preference*

What is your preference for internship? Please indicate at least your first and second choices:
1st Choice:	2nd Choice:	3rd Choice:
Fall Summer Spring	Fall Summer Spring	Fall Summer Spring
Choose Year 2008 2009 2010	Choose Year 2008 2009 2010	Choose Year 2008 2009 2010

Previous Komen Interns

Have you known anyone who has participated in a Komen internship?	Yes No
If yes, please specify:

I. Résumé

Please attach your résumé (Please submit a Word or text only file, no larger than 100k.)*

II. Transcript

Please attach your Transcript