Intern Form

Note: Fields marked with an * are required.

Biographical Information

Full Name *

Gender *

Male Female

Birthdate *

Primary Phone *

Secondary Phone

Email Address *

Parents/Guardians *

Hometown *

Preferred Name *

Current Address

Address 1 *

Address 2

City *

State *

AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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

Zip Code *

Address Current Until

Permanent Address

Address 1 *

Address 2

City *

State *

AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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

Zip Code *

Academic Information

High School

Name of High School *

Graduation Year *

Grade Point Average *

College

Name of College *

Year in School *

Major(s) *

Minor(s)

GPA *

Do you plan to seek academic credit for this internship?

Yes No

Advisor

Name

Phone

Email

References

Please list two (2) individuals who will be writing your letters of recommendation.

Academic Reference

Name *

Title

Address

City

State

AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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

Zip Code

Daytime Phone

Email

Relation To You *

Character Reference

Name *

Title

Address

City

State

AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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

Zip Code

Daytime Phone

Email

Relation To You *

Areas of Interest

Please indicate your top five areas of interest *

Agriculture Business Defense Education Energy Environment Foreign Relations Health Care Labor Relations Public Lands Trade Transportation

Session Dates and Locations

Please state the session for which you are applying: *

Preference for internship location: *

Washington, DC Energy and Natural Resources Committee Rock Springs Cheyenne Casper Sheridan

Short Essays

Please answer the following questions. Essays must be at least 300 words.

Choose one of your extra curricular activities and describe how it has prepared you for an internship in the office of Senator Barrasso. *

Teamwork is a necessity in our office to keep things going smoothly. What unique skills and experience can you bring as a team member? *

What do you plan to take away from this experience that fits your long-term goals? *

Additional Information

How did you hear about this internship opportunity?

Senator Barrasso's Website News Publication Academic Program Professor/Advisor Career Center/Fair Student Association Friend/Relative Other

If you heard about this opportunity from a specific person or program, let us know here:

I confirm that the above answers are true, accurate and complete to the best of my knowledge. I understand that any falsification in my answers will lead to the rejection of my application or dismissal from the program and I will not be allowed to re-apply. If selected, I hereby agree to abide by the rules and regulations for congressional employees and the office of Senator John Barrasso.

I Agree

Please remember to send your resume and two recommendation letters to my internship coordinator at internship@barrasso.senate.gov.