Your Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender Identity

Pronouns

Race/Ethnicity Identities (optional)

Current College

Level of education for internship year

Area of study

This position is a one year commitment, are you able to give the required one-year commitment

If you are a DU student, please be aware that the position starts earlier than the DU, is this something you are able to do?

This position requires attendance at a 36 hour helpline training in August and a flexible schedule on non-class days to accommodate clients. Is this something you are able to commit to?

This position requires you to take on-call shifts on the 24/7 helpline once trained, which may include weekends. Is this something you can commit to?

Please select all that apply to your experience

These are not required to be an intern, we just want to get to you know you!

I have worked with trauma

I have worked on a hotline

I have worked one one one with clients

I have worked on a team

I have worked in crisis intervention

I have taught topics of gender violence

Have you ever experienced IPV?

This is very optional! Many who work in this field have lived experience, and doing this work requires self-awareness and care we wish to cultivate with you

How do you feel this might help and/or interfere with your role as a PCA intern?

Undergraduate Institution

Undergraduate Major or Title of Degree

Minor

or concentration/work/research/acitivities you want us to be aware of

Semester of Graduation

Year of Graduation

Graduate Degree (if already completed)

Only fill this out if you have already obtained another graduate degree than the one you are currently working on. If so, please include the name the institution, your degree title and the year/semester of completion

Have you ever been arrested or charged with anything other than a minor traffic offense?

If yes, please explain:

Have you ever been convicted of a felony?

If yes, please explain:

Do you use alcohol and/or habit forming substances excessively or regularly?

If yes, please explain:

Have you ever had a protection order against you?

If yes, please explain:

Have you lived in a state other than Colorado since you were 18 years old?

Yes

If yes, please list the states and dates you lived there:

Reference 1 Name

First Name

Last Name

Reference 1 Relationship to You

Please do not include relatives or friends

Reference 1 Phone

(###)

###

####

Reference 2 Name

First Name

Last Name

Reference 2 Relationship to You

Please do not include relatives or friends

Reference 2 Phone

(###)

###

####

Reference 3 Name

First Name

Last Name

Reference 3 Relationship to You

Please do not include relatives or friends

Reference 3 Phone

(###)

###

####

Name of Emergency Contact

First Name

Last Name

Relationship to emergency contact

Phone for emergency contact

Country

(###)

###

####

Address for emergency contact

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I consent to a background check

Yes

No - I am aware this will disqualify me from an internship with the PCA

I confirm that I will email my resume/CV to harriet.mctigue@ucdenver.edu within 24hrs of submitting this application

Yes

By writing my name below, I certify this as a signature and that the information on this application is complete and true to the best of my knowledge. I understand that discovery of misrepresentation or omission of facts could be cause for immediate dismissal or disqualification from the application process. I authorize The Phoenix Center at Auraria (PCA) to investigate all statements contained in this application for a field placement, as well as my character and qualifications. I authorize PCA to contact any of my references for full information. I authorize all listed references to provide PCA with information requested in the inquiry of my character and qualifications. I understand that a criminal record check will be conducted on my background.

Today's Date

YYYY

Thank you for your interest in becoming a graduate advocacy intern for the Phoenix Center at Auraria! Please email your resume/cv (and optional cover letter) or any questions to the Assistant Director of Advocacy Services, Harriet McTigue at harriet.mctigue@ucdenver.edu. If your application is selected, Harriet will reach out to you as soon as possible to coordinate an interview. Please note: all internship opportunities are contingent upon successful completion of a background check.

Graduate Advocacy Internship Application