Form

Ford Environmental Leadership Internship
for High School Students
2013 Application and Interest Form*

Students who are completing their freshman, sophomore, or junior years in June 2013 and attend a high school that participates with the CIMBY program are encouraged to apply. Students are welcome to submit their résumés although they are not required. Applications must be received by April 17, 2013. *Upon selection for interview, additional application material will be required.
Sponsored by:
Personal Information
Full Name*
First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail
Home Phone*
- Area Code Phone Number
Cell Phone
- Area Code Phone Number
Birth Date*
Month Day Year
School:
What grade are you in?
Are you a CIMBY program participant?

Yes No
If so, who’s your CIMBY contact teacher?
Short Answer Questions
1. Tell us about yourself. Write freely about who you are.
2. What are some of your personal, academic, and career goals?
3. Tell us about one environmental challenge in your community and what you would do to address it.
4. Do you have previous job or volunteer experience? If so, please describe.
5. Do you have experience working in groups? If so, what qualities do you have that make you a good team member?
6. What skills and strengths will you bring to this internship? (i.e. familiarity with computer programs, leadership tools, public speaking, etc.)
7. What do you hope to gain through this internship program?
8. Can you commit to working Monday, July 1st through Thursday, August 15th, from 9:00am to 4:30pm four days a week and participate in one activity a month during the school year? (Activities include Saturday restoration work days, school leadership events, community events, and skills workshops among others.)
Reference

Please provide contact information for a high school teacher or another non-related adult who can let us know about your ability to participate with the internship program.
Reference Name
First Name Last Name
Reference Phone Number
- Area Code Phone Number
Reference E-mail
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All applications must be received by April 17, 2013. You may submit this application online by clicking the submit button below or print it out and send to: Jessica Canas, The Field Museum – ECCo Division, 1400 S. Lake Shore Drive, Chicago, IL 60605 or Email: jcanas@fieldmuseum.org. Fax: 312 665 7433
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For further information about the internship program and questions, please contact Jessica Canas at (312) 665-7443 or jcanas@fieldmuseum.org
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Ford Environmental Leadership Internship

for High School Students

2013 Application and Interest Form*

Sponsored by:

Personal Information

Short Answer Questions

Reference

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