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* 1. Name of Community Agency

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* 2. Please provide the name (including pronouns), role and email address of the person who is completing this form (e.g. community agency leader or an academic partner, scholar or AVA Lead on behalf of a community agency)

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* 3. Name of person at the agency that will be leading the internship
Note: This person will be referred to the Agency Internship Leader.

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* 4. Agency internship leader's preferred pronouns 

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* 5. Agency internship leader's email address

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* 6. Is there someone co-leading this internship?

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* 7. Please provide the contact info for the person co-leading the internship

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* 8. Agency internship leaders and co-leaders (if applicable) must read the AVA Community Agency Internship Overview document. This is required to submit the application.

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* 9. Do you have a scholar/intern (i.e. graduate student or post-doctoral fellow) in mind whom you would like to complete an internship at your agency?

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* 10. Please choose one of the options below that best represents your current relationship with the AVA Triadic Mentorship Program and pathway into the Community Agency Internship Program.

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* 11. If the agency internship leader or co-leader is currently participating in the AVA Triadic Mentorship program, please specify the academic mentor’s name below.

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* 12. The duration of an internship is 3 months; however, this can be “stacked” for longer experiences, up to a maximum of 12 months. Interns will be available to work a minimum of 10 hours per week, to a maximum of 20 hours per week with the agency during this time. Please specify below if you would like to host an intern for 3, 6, 9 or 12 months.

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* 13. Please briefly tell us about what skills or expertise (e.g. community-based research, grant writing, early childhood adversity, etc.) the Agency Internship Leader and Co-Leader (if applicable) will contribute to leading an intern in the AVA Community Internship program (feel free to note skills/expertise in point-form; Maximum 250 words).

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* 14. Do you have a project in mind that you would like an intern to work on? If yes, please briefly describe the project(s) or work you would like the intern to engage in (use point form if preferred; maximum 250 words). Please include the required start date and hours required). You can click here for a list of possible project ideas.

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* 15. If you do not have a project in mind, please choose from the options below to provide more information and assist the AVA team with meeting your agency's needs.

AVA’s Objectives
· Strengthen and build capacity to transform population (community) health and social services to promote the health and wellness of girls, women, and gender-diverse people, at risk/affected by violence and adversity over the lifecycle;

· Use a collaborative, innovative, cross-sectoral/disciplinary/jurisdictional training platform to train hundreds of Canadian service providers and academics in the social services/community health field working with this population; and

· Make intergenerational and population impacts, and promote a positive lifespan for girls, women, and gender-diverse people.

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* 16. Please briefly describe how this project/work will align with AVA’s objectives, outlined above (Maximum 100 words).

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* 17. Will this project/work be virtual or in place? If the project/work will require the intern to be on-site, what is the location of agency (City & Province)? Please include details such as when you would like the intern to start and the number of hours/week it is anticipated that the intern will be working for the agency. Please note that AVA interns may work a maximum of 20 hours per week.

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* 18. Please check below to confirm that you have read and understood the AVA Guiding Principles and Equity, Diversity, Inclusion and Accessibility Principles document. This is required to submit the application.

Thank you for applying to host an intern through the AVA Community Agency Internship program! An AVA team member will contact you once the application has been reviewed.

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