INTERN APPLICATION
The Barber National Institute welcomes Interns in a variety of programs and activities. To apply, fill out the application below. We no longer accept paper applications and have provided a kiosk available in our North Lobby for those who do not have a computer readily available. Any questions can be directed to the Governance, Risk Management and Compliance Office.
APPLICANT MUST BE AGE 18 OR OVER
GENERAL
Name:
Home Address:
Email Address: Contact Number:
Required Clearances: State Police, Child Line/DPW, FBI and others may be requested depending on the program of interest
Emergency Contact Person: Relationship: Contact Number:
**Please complete sections below**
INTERN
High School/College/University Name:
Level of Education (High School/Undergrad/Graduate/Other):
Course Title: Course Number:
Instructor's Name: Instructor's Contact Number:
Instructor's Email:
Number of Hours Required: Type of Hours:
Days/Times Student is Available:
Requirement:
Requested Start Date: Expected End Date:
Availability/Requested Times:
Program of Interest if known:
If other, please explain
Request Experience with:
Are There Specific Requirements for your time:
Type Full Name  
Today's Date  
By checking this box, I hereby certify that this information is accurate and complete. I Agree