Lakeshore Foundation Therapeutic Recreation Internship Application by zuu19905

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									                                Lakeshore Foundation
                           Therapeutic Recreation Internship
                                  Application Form
Personal Information

First Name_________________________ Middle Initial______ Last Name___________________________

Date of Birth (M/D/Y)_________________ Age______         □   Male    □ Female

Email Address ________________________________

Address _____________________________________ City__________________ State ______ Zip________

Home Phone ___________________ Cell Phone ______________________

College / University Information

Address:______________________________________ City__________________ State ______ Zip_______

School Advisors      Name____________________________________

                     Phone_____________________ Email Address________________________________

Major_________________________________________ Anticipated Graduation Date__________________

   •   How did you learn about Lakeshore Foundation: ___________________________________________

   _____________________________________________________________________________________

   •   Explain why your are applying for a community-based therapeutic recreation internship experience:__

       __________________________________________________________________________________

       __________________________________________________________________________________

       __________________________________________________________________________________

   •   Explain your special areas of interest: ___________________________________________________

       __________________________________________________________________________________

       __________________________________________________________________________________

   •   What do you hope to gain from your internship experience at Lakeshore Foundation? _____________
       __________________________________________________________________________________

       __________________________________________________________________________________

       __________________________________________________________________________________

   •   List any major or minor physical impairments you have which may need special consideration.

       __________________________________________________________________________________

       __________________________________________________________________________________

   •   With your Internship Application, submit a resume which includes all experiences that qualify a pre-
       internship experience. Please be concise but comprehensive, giving description of type and name of
       organization, type of client populations, dates, responsibilities, and accomplishments.


I have sufficiently investigated this program and realize the expectations. I am confident that I can adjust to
the structure of the program, and will accept the responsibilities inherent therein.


________________________________________________
Signature

________________________________________________
Date

								
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