Advocate for survivors in 2016

Safe Harbor Shelter

9 years ago

LEGISLATIVE ADVOCACY (2)

Wish you could take action against sexual and domestic violence in our community?

Here’s something you can do: Join Safe Harbor to advocate for survivors’ interests during Virginia’s legislative session!

Fill out the form below to stay informed on the issues we’re watching, then join us to contact our legislators. Save the date for Legislative Advocacy Day on Jan. 27, and join us to represent our cause at the General Assembly!

Now you can do something – are you in?

SAFE HARBOR INTERNSHIP APPLICATION

What internship(s) are you applying for?*
- Counseling and Advocacy Team Internship Program
- Community Outreach Internship Program
- Human Trafficking Shelter Internship Program
- Domestic Violence Shelter Internship Program
- Court Advocacy Internship Program
APPLICANT INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Pronouns*
EDUCATION
Current School:*
Major/Program:*
Expected Date of Graduation:*
Previous School:
Major/Program:
Date of Graduation:
EMPLOYMENT
Current or Most Recent Employment
Company:*
Title:*
Responsibilities:*
Other Relevant Employment Experience
Company:
Title:
Responsibilities:
VOLUNTEER AND INTERNSHIP EXPERIENCE
Volunteer/Internship #1
Company:*
Title:*
Responsibilities:*
Volunteer/Internship #2
Company:
Title:
Responsibilities:
Volunteer/Internship #3
Company:
Title:
Responsibilities:
AVAILABILITY
What semester(s) are you applying for?*
What are the hours requirements for your practicum/internship?*
What is your proposed start date and end date?*
Please indicate your available hours during the week:
Monday Start Time

: HH

MM
Monday End Time

: HH

MM
Tuesday Start Time

: HH

MM
Tuesday End Time

: HH

MM
Wednesday Start Time

: HH

MM
Wednesday End Time

: HH

MM
Thursday Start Time

: HH

MM
Thursday End Time

: HH

MM
Friday Start Time

: HH

MM
Friday End Time

: HH

MM
What are your site supervisor requirements for your practicum/internship (e.g. licensed, # of years of clinic experience, etc.)?*
EXPERIENCE AND SKILLS
Are you bilingual or multilingual?*
- Yes
- No
If yes, in what languages are you fluent?
Do you have any experience working in a crisis situation?*
- Yes
- No
If yes, please give a brief description of the experience:
Do you have any experience working with survivors of domestic violence, sexual violence or human trafficking?*
- Yes
- No
If yes, please give a brief description of the experience:
Why are you interested in interning at Safe Harbor?*
Please describe your career goals.*
What special skills or experiences would you bring as an intern at Safe Harbor?*
PLEASE PROVIDE THREE PROFESSIONAL REFERENCES:
Reference #1:
Name*
First Last
Relationship:*
Company:*
Title:*
Phone*
Email*
Reference #2:
Name*
First Last
Relationship:*
Company:*
Title:*
Phone*
Email*
Reference #3:
Name*
First Last
Relationship:*
Company:*
Title:*
Phone*
Email*
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Wish you could take action against sexual and domestic violence in our community?

Now you can do something – are you in?

SAFE HARBOR INTERNSHIP APPLICATION

APPLICANT INFORMATION

EDUCATION

EMPLOYMENT

Current or Most Recent Employment

Other Relevant Employment Experience

VOLUNTEER AND INTERNSHIP EXPERIENCE

Volunteer/Internship #1

Volunteer/Internship #2

Volunteer/Internship #3

AVAILABILITY

Please indicate your available hours during the week:

EXPERIENCE AND SKILLS

PLEASE PROVIDE THREE PROFESSIONAL REFERENCES:

Reference #1:

Reference #2:

Reference #3:

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