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Internship Application Jan10

Internship Application Jan10

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Published by: yeyint on Feb 05, 2010
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Internships Asia - P.O. Box 130, Mae Ping Post Office, A. Muang, Chiang Mai, Thailand, 50301 - www.internshipsasia.org - apply@internshipsasia.org
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Please complete and return this form and all relevant documents by March 12, 2010
For application instructions, please refer to the "2010 Internship Overview", or visitwww.internshipsasia.org. Questions/Comments about this program or the application process? E-mailapply@internshipsasia.org.
2010 Regional Internship Program for Myanmar Nationals - Intake #1
Application Form -January 2010
ETHNICITY:RELIGION:
Diversity Survey
 
(optional)E-Mail from IAFaculty MemberFriend or RelativeInternetOther 
(Please Specify)
How Did You Hear About This Program?Disability Survey
 
(optional)DO YOU HAVE ANY CHRONIC PHYSICAL ORMENTAL HEALTH ISSUES?Yes
*
No
If YES, please describe your health issue, as well as any services or medicines you require. This information will bekept confidential and used solely for planning purposes.
Other Contact Information
MOBILE TELEPHONEE-MAIL ADDRESSES
Phone Number  Area CodeCountry Code
Primary:Secondary:
Emergency Contact Information
NameRelationshipE-Mail:
Country CodeArea CodePhone Numbe
 Telephone:Please provide us with information on who tocontact in the event you are seriously ill or injured.PERMANENT ADDRESS FOR YOUR PARENTS OR GUARDIANSStreet:Village/City:State:Country:Postal Code:YOUR CURRENT ADDRESS
Until 
Year Month
 Telephone:
Phone Number  Area CodeCountry CodeCountry CodeArea CodePhone Numbe
 Telephone:DO YOU HAVE A VALID PASSPORT?MALE FEMALEStreet:Village/City:State:Country:Postal Code:FULL NAME:OTHER NAMES:
Please Specify 
Personal Information
Year MonthDay 
DATE OF BIRTHPLACE OF BIRTH
Village/City Country State/Province
Month
*
 Along with this completed application, please provide us with anelectronic copy of the photo page of your passport (if available).
Expiration Date
Yes
*
NoI have applied, and I expect to receive it by:
 
Internships Asia - P.O. Box 130, Mae Ping Post Office, A. Muang, Chiang Mai, Thailand, 50301 - www.internshipsasia.org - apply@internshipsasia.org
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2010 Intern Application for:
2 of 7Your General Areas of Interest
In order for us to get to know you better, please select three choices from the options below that interest you the most. Pleasenumber your selections in order of preference: 1, 2, 3, indicating your first, second and third choices.-- COMMUNITY ART, MUSIC& THEATRE-- ADVOCACY-- INDIGENOUS PEOPLE& CULTURE-- HEALTH PROMOTION-- INFORMATION TECHNOLOGYFOR DEVELOPMENT-- YOUTH & FAMILY-- OTHER:-- CORRUPTION-- DISABILITY ISSUES-- EDUCATION-- GENDER & SEXUALITY
(please specify)
-- RURAL DEVELOPMENT-- ENVIRONMENT & ECOLOGY-- LAW & LEGAL ASSISTANCE
You and Your Home Organization
In order to participate in IA's Regional Internship Program, you must be currently working or volunteering with a developmentorganization (preferably) in Myanmar. In this section, you can tell us about your organization, and whether you have support toparticipate in this program.Country Location:Organization Name:Your Job Title: Type of PositionYes NoNoYes*Do you have a letter of support from your organization that's required to participate in the program?List your responsibilities within the organization, duties performed, skills used, advancements, or promotions received:
(3)
Do you have specific projects on which to work when you have completed your internship?
* If YES, we strongly encourage you to describe your plans within essay #3 of this application
Supervisor's E-Mail:Supervisor's Name:
Yes NoHave you discussed this program with your supervisor or the senior staff of your organization?
Advertised Placement for Which You are Applying
 The Regional Internship Program has been redesigned so you can directly apply for specific internship opportunities we advertisefor each intake of the program. If you haven't already done so, go online towww.internshipsasia.orgto review all the availableplacements where you could intern during this intake. In the spaces below, please outline your internship preferences as theyrelate to positions on the IA website.
This section must be completed by all applicants.
If you do not see a position that interests you, please contact us to learn what plans we may have for advertising futureplacements in your area of interest.
(1)(2)
Please write the name of your preferred placement here:First Placement Preference*Second Placement Preference
(1)(2)
*The content of your application should reflect this preference - especially within the content of your essays.
 
Internships Asia - P.O. Box 130, Mae Ping Post Office, A. Muang, Chiang Mai, Thailand, 50301 - www.internshipsasia.org - apply@internshipsasia.org
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Educational Attainment
Select the Highest Level of Formal Education You Have Attained:PLEASE LIST THE THREE (
3
) MOST RECENT EDUCATIONAL INSTITUTIONS YOU ATTENDED(most recent first)Submit copies of your grade transcripts or certificates along with this form. These documents may be mailed separately bypost if unavailable in an electronic form.Name of Institution:
Year Month
Country Location:Dates Attended:
Year Month
to
1)
 Type of School:Subjects/Majors Studied:
2)3)
MonthYearMonthYea
toDates Attended:Country Location: Type of School:Name of Institution:
MonthYearMonthYea
toDates Attended:Country Location: Type of School:Name of Institution: TRAINING SEMINARS & WORKSHOPS RELATED TO YOUR FIELD(S) OF INTERESTPlease list the 5 most RELEVANT trainings you attended.
DO NOT
 
send any copies of certificates with your application.
Certificate ReceivedDurationYearTraining OrganizationName of Training or Workshop 1:2:3:4:5:
Degree or Certificate:DO YOU PLAN TO APPLY FOR UNIVERSITY/COLLEGE SCHOLARSHIPS?Subjects/Majors Studied:Degree or Certificate:Subjects/Majors Studied:Degree or Certificate:Yes. I plan to apply for scholarships
during or immediately after
the completion of an internship.No.Yes. I have
already
applied to:Maybe. I might apply for scholarships in the next few years.
2010 Intern Application for:
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