What's your email address?

Your information


Required fields are marked with an asterisk (*).
First Name *
Last Name *
Middle Inital
Address *
City *
State *
Zip Code
Home Phone Number
Cell Phone Number

For example, 123-456-7890
Birth Date *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
What department are you wanting an internship in?
How did you hear about Shorehaven's Internship program?
References: Please provide two references we may contact. First and last name, phone number, and relationship to you. *
Which days(s) are you available?






How often and what hours are you available?
Have you ever been convicted of a felony, misdemeanor, or ordinance violation other than a traffic violation? If yes, please explain in the box below.
Emergency Contact: In the event of an accident or illness while serving at Shorehaven, the person listed will be called if necessary. Please provide a first and last name, address and phone number(s). *
Please provide your license plate number (s) of the vehicle(s) you drive to Shorehaven so you can be contacted regarding parking lot concerns (ex: flat tire, headlights left on, etc.)

Waiver

I certify that the information in this application is correct to the best of my knowledge. I authorize Shorehaven to check the references I provided and check with the appropriate public authorities regarding my background. I understand that should I be offered a volunteer/Intern position, any misrepresentation by me may lead to termination. I also understand that my volunteer service can be terminated, with or without cause and/or notice, at any time. I understand that completing the application process does not guarantee acceptance as a volunteer.
I authorize Shorehaven to publish my name, picture, testimonials and/or survey results in marketing materials which promote the organization and its programs. This includes but is not limited to: video, advertising, publications, website, annual reports, committee reports and social media. I understand no compensation will be paid to me. I understand that Shorehaven will be held harmless for any unauthorized reproduction of information by parties not authorized by the organization.