Contact Information

Your Name *

Street Address *

City *

State *

Zip Code *

Email *

Birthday *

Home Phone *

Cell Phone *

Cell Phone Provider
AT&TSprintVerizonT-MobileVirginOther

May we send you text messages?
YesNo

Are you bilingual? *

If yes, what languages can you speak?

College Information

College Name *

College Address *

Internship Advisor *

Advisor Phone *

Advisor Email

Your Major *

Your Minor *

Internship Credits Needed *

Availability

Semester Available
FallWinterSpringSummer

During which days are you available? We are open from 9-5 Tuesday through Friday and 12-5 Saturday and Sunday. Special events may occur in the evening or on weekends.

Days Available
TuesdayWednesdayThursdayFridaySaturdaySunday

Departments of Interest

Animal Care & EnrichmentCollections ManagementEarly Childhood (Toddler - K)Humanities Education (K- 5)Science Education (K - 5)Marketing DevelopmentOther

Why do want to intern at the Lutz Children's Museum?

What qualities will you bring that will benefit our organization?

What are you goals after completing college?

References

Please give us three personal or professional references (an adult who has known you for more than a year and is not a relative - for example: a current or former employer, guidance counselor, principal, coach, teacher, spiritual leader, or volunteer supervisor).

Reference One

Name *

Relationship *

Phone *

Email

Reference Two

Name *

Relationship *

Phone *

Email

Reference Three

Name *

Relationship *

Phone *

Email

Signature

Intern Signature *

Date *