Year:*

Desired Session (select one):*

Fall Semester Spring Semester Summer

First Name:*

Last Name:*

Street Address (during internship period):*

Street Address Continued:

City:*

State:*

Zip Code:*

Email:*

Phone Number:*

College or University:*

Select the year you are NOW:*

Freshman Sophomore Junior Senior

Earliest starting date that you commit to:*

Latest ending date that you commit to:*

Class/activity schedule between those two dates (do not include travel time):*

List any preferences for days of the week or times of day:

I commit to completing an internship in Congressman Khanna’s district office if my application is accepted. I will not quit the internship while it is in progress, regardless of what other opportunity I might be offered.