INTERNSHIP APPLICATION

This form is for all Reentry Apprenticeship Program (RAP) participants to complete during their orientation.

Your name *

Email address *

CONTACT INFO

Phone number *

Birthdate *

Primary campus *

Do you have a valid CA ID (Picture ID)? *

Do you have a current CA Driver's License? *

Are you employed? *

Select 'Yes' ONLY if you have a part/full time job at this time and have already received your first paycheck.

Do you have a bank account? *

Are you enrolled in school (academic or vocational)? *

What about the human service & hospitality industries interests you? *

Do you have Medical Insurance? *

Medical Information

Please share any serious food allergies or medical conditions or medications that you have below:

This is regarding parole or probation supervision.

Freedom Date *

Please share when you came home from incarceration and began your reentry journey.

How long have you been incarcerated? *

Please share how long were you incarcerated during your last term & your total amount of lifetime incarceration below.

Are you on any parole or probation supervision? *

Supervision Contact *

Please share your Parole/Probation officer information below (Name, Phone Number, Email).