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INTERN APPLICATION

I would like to apply for admission to the Obama for Iowa Internship Program

APPLICANT INFORMATION

NAME (last, first, middle)

__________________________________________________________

CURRENT ADDRESS

__________________________________________________________

__________________________________________________________

CURRENT TELEPHONE

__________________________________________________________

PERMANENT ADDRESS

__________________________________________________________

__________________________________________________________

DATE OF BIRTH __________ / __________ / __________

SOCIAL SECURITY NUMBER __________ - __________ - __________

COUNTRY OF CITIZENSHIP ________________________________ M _______ F _______

LANGUAGES SPOKEN (State language & State if: Fluent, Conversational, Slightly, Read Only)

____________________ ____________________ ____________________

COLLEGE OR UNIVERSITY
Paid for(if
andnot a current
authorized student…please
by Obama proceed to Work Experience)
for America. www.barackobama.com
Name __________________________________________________________

Major ____________________

Expected Date of Graduation ____________________

Approximate Dates of Availability for Internship ____________________

I am applying for:

Fall semester 20 ____ Spring Semester 20 ____ January Term 20 ____ Summer 20 ____

While in Iowa, I will be a (circle one)

___ Sophomore ____Junior ____Senior _____ Recent Graduate _____Graduate Student

WORK EXPERIENCE

List all work experience, beginning with your most recent employer or submit current resume.

1. Employer
__________________________________________________________

Address
__________________________________________________________

Telephone Number ( )_
_____________________________________________________

Dates of Employment
__________________________________________________________

Title/Duties

2. Employer
__________________________________________________________

Address
__________________________________________________________

Telephone Number ( )
__________________________________________________________

Dates of Employment
__________________________________________________________

Title/Duties

Paid for and authorized by Obama for America. www.barackobama.com
3. Employer
__________________________________________________________

Address
__________________________________________________________

Telephone Number ( )
__________________________________________________________

Dates of Employment
__________________________________________________________

Title/Duties

SPECIAL SKILLS

Computer Skills

Office Skills

Why do you want to intern for Obama for America?

What do you see your self doing for Obama for America during your internship?

Please email completed application to mblake@barackobama.com
For questions call Mike Blake at 515.883.2008

Paid for and authorized by Obama for America. www.barackobama.com