Intern - Apply As Intern.

APPLICATION FORM FOR INTERNSHIP PROGRAM
PART A
Name:
Date Of Birth:
Present Address:
Phone No:
If you do not have a phone at your current residing place, please give an alternate number
Permanent Address:
City:
State:
Zip/Pin:
Contact No:
Email Id:
Country:
Intership Program:
(Mention the date and duration)
Name Of Institute:
Course:
Year / Semester:
Education Details: Mention the details of the last courses/schooling undertaken
Education Degree/Certificate Institution Year Passed %
PART B
Career Goals:
Write a brief note on your career goals. (100 words)
Knowledge skills:
How can you utilize your knowledge skills in social sector? (100 words)
PART C : About the internship program
Mention your preferred area of working: Urban resettlement Colonies
Drug Deaddiction and Rehabilitation
Rural areas of Gurgaon
Mention your preferred choice of subject (Rank top three):
Child Education Women Empowerment Youth
Maternity Child Health Adult Education Environment
Legal issues Counseling Village Governance
Drug Deaddiction Vocational Training Software Developing
Human Resource Advocacy & Awareness Health
Research & Documentation
Declaration
I certify that the above information is complete, accurate and nothing has been concealed. I have also read the rules and regulations of the internship program and agree to abide in the best of my spirits.

POLL
Q: Drug Abuse is an illness and not a habit
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