VA National Diversity Internship Program - Student Application

Applicant Name

First Name *

Middle Name *

Last Name *

Permanent Address

Address *

Room/Apt:

City *

State *

Zip Code *

Address while at school

Address *

Room/Apt:

City *

State *

Postal Code *

Email/Phone

Email (Primary) *

Email (Alternate)

Phone (Primary) *

Phone (Alternate)

School Information

School *

Professional School

City *

State *

Zip Code *

Are you a US citizen? *

Student Status - As of September 2021, I am a: *

Graduation Semester: *

Graduation Year: *

If you are graduating in the Fall of 2021 and attending a graduate program in the Spring of 2022, you will be asked to provide proof of your acceptance to a graduate program.

Degree Information

Faculty Advisor *

Major *

Minor

GPA: *

Relevant Courses *

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List awards:

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How did you find out about the VA National Diversity Internship Program? *

Name of counselor, faculty member or sponsored program/workshop:

Have you participated in past internships with the VA National Diversity Internship Program? *

Underrepresented Minority- Check all that apply *

ADA recognized disability?

What do you hope to gain from this internship and what do you think you can offer to an organization? * 🛈

0/255 characters

Complete an essay not to exceed 400 words, explaining why you desire an internship/career at the VA. * 🛈

0/400 words

Provide the names and email addresses of two professors/advisors who will provide a recommendation. An email will be sent to them notifying your recommenders that you are applying for an internship.

Recommender Name (1) *

Email (1) *

Recommender Name (2) *

Email (2) *

Student applicants must provide an official copy of his/her most recent academic transcript and resume with this application.

Transcript *

Resume *