Summer Internship Application General Question Title * 1. Contact Information First Name Last Name Street Address Street Address 2 City/Town State/Province ZIP/Postal Code Email Home Phone Cell Phone Question Title * 2. When is your birthday? Date Date Question Title * 3. Which options are you applying for? (Select all that apply) Haiti Only: July 8-15, 2017 3 Week Program (Haiti plus time on campus): July 1-22, 2017 Week 1: June 24-July 1, 2017 Week 2: July 22-29, 2017 Week 3: July 29-August 5, 2017 Week 4: August 5-12, 2017 Week 5: August 12-19, 2017 Question Title * 4. Please select the best days/times to contact you. Sunday Morning Sunday Afternoon Sunday Evening Monday Morning Monday Afternoon Monday Evening Tuesday Morning Tuesday Afternoon Tuesday Evening Wednesday Morning Wednesday Afternoon Wednesday Evening Thursday Morning Thursday Afternoon Thursday Evening Friday Morning Friday Afternoon Friday Evening Saturday Morning Saturday Afternoon Saturday Evening Question Title * 5. Are you on Facebook? Yes No Next