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Asian Pacific American Student Services

Together In Empowerment (TIE) Intern Application 2010-2011

Mr. / Ms. First Name Last Name

Local Number / Street Apt. #

Address City State Zipcode

Home Phone # Cell Phone # Email Address

Major(s) Minor(s) Year in School

Please list the community-based organizations you are applying to work at in order of your preference:

1) ____________________________________________________________________________________________

2) ____________________________________________________________________________________________

3) ____________________________________________________________________________________________

4) ____________________________________________________________________________________________

5) ____________________________________________________________________________________________

What do you hope to gain from this internship experience? Feel free to attach your response separately if you need more space.

By signing and dating the line below, you acknowledge that you have read and understand the responsibilities of the internship for
which you are applying for. Also, you acknowledge that the information in your resume is true and correct.

Signature ___________________________________________________ Date ___________________________________

Please include your resume and submit to the APASS office in STU 410, or via email to
APASS Assistant Director Jade Agua at by Friday, December 3, 2010.