Application

Name:

College/university:

Year:
Senior Junior Sophomore Graduate Graduate Student

Major:

Expected graduation date:

Minor:

Current Address:

Permanent Address:

Telephone: (Current)

Telephone: (Permanent)

Political affiliation:
Republican Democrat Other

Email Address:

Grade Point Average

College activities, honors, awards:

Government or political experience (employment, campaign volunteer work, etc.):

Areas of public policy interest (environment, education, health care, taxation, etc.):

What specialized skills do you have?

Writing sample

1.) Write an essay (200 words or less) on why you want to serve in the Senate intern program and what you hope to gain from this experience.

Work Experience

1) Employer:

Title/Position:

Immediate Supervisor:

Responsibilities:

Supervisor Title:

Supervisor Contact Phone Number:

Beginning date / Ending date:

2) Employer:

Title/Position:

Responsibilities:

Immediate Supervisor:

Supervisor Title:

Supervisor Contact Phone Number:

Beginning date / Ending date:

References

Name:

Address:

City:

Title:

Telephone:

Name:

Address:

City:

Title:

Telephone:

I certify that there are no misrepresentations or falsifications of these statements and answers. I am also aware that falsification of this application, or any accompanying data, may result in my dismissal from the Senate Intership Program.

In addition to submitting the above online application, please submit a resume, an academic transcript (unofficial copy is acceptable), at least two letters of recommendation, and a writing sample to jcarlton@iga.in.gov.

Or Mail: Jen Carlton, Senate, State of Indiana, 200 W. Washington St., Room 130, Indianapolis, IN 46204-2785.