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VA National Diversity Internship Program - Student Application
Applicant Name
First Name
*
Middle Name
*
Last Name
*
Permanent Address
Address
*
Room/Apt:
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Address while at school
Address
*
Room/Apt:
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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?
*
Yes
No
Student Status - As of September 2021, I am a:
*
Junior
Sophomore
Senior
Graduate Student
Graduation Semester:
*
Spring
Summer
Fall
Winter
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
*
+
-
List awards:
+
-
How did you find out about the VA National Diversity Internship Program?
*
Faculty Member
University Workshop
University Counselor
Internet
Other
Other
Name of counselor, faculty member or sponsored program/workshop:
Have you participated in past internships with the VA National Diversity Internship Program?
*
Yes
No
Underrepresented Minority- Check all that apply
*
Alaskan Native
American Indian
Black/ African American/ Caribbean American
Hispanic/ Latino
Pacific Islander/ Hawaiian
Woman
Disabled
Other
Other
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
*