Name:_____________________________________________________________________________

Present Address:_____________________________________________________________________

Present Telephone Number:_____________________________________________________________

Home Address (if different from above):____________________________________________________________________________

Home Telephone Number (if different from above):____________________________________________________________________________

E-mail address:______________________________________________________________________

Higher Education Institution:_____________________________________________________________

Present Status: _____ First Year _____ Sophomore _____ Junior _____ Senior

Advisor’s Name:_____________________________________________________________________

Major Field of Study:__________________________________________________________________

Issue Area(s) of Interest (i.e., health care policy, education etc.)_______________________________________________________________________________

Preferred location:    ______Washington     ______New Haven

Internship Preference: _____ Fall _____ Winter _____ Spring _____ Summer

Dates of Availability:_______________ to _______________ Days Available______________________

Are you applying for an academic internship offered through your college or university?
(If not, we will help you design an educational program for your internship.)

Additional Comments:__________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

With this application, please include a cover letter, resume, a brief writing sample, and two references, and a wallet sized photo.

Please send your completed application and supporting materials to the appropriate office. Fax and email are strongly recommended, as postal mail is subject to testing and delays.

Washington, DC Internship                                   or                               District Office Internship

The Honorable Rosa L. DeLauro                                                            The Honorable L. Rosa DeLauro
2262 Rayburn House Office Building                                                       59 Elm Street
Washington, D.C. 20515                                                                         New Haven, CT 06510
Attn: Todd Sloves                                                                                    Attn:  Jennifer Lamb

Fax: 202-225-4890                                                                                 Fax: 203-772-2260

(If you would like to email your application,
cut and paste the application and click on the link above)
 

Applicants and employees shall not be discriminated against with respect to compensation, terms, conditions, or privileges of employment, because of such person’s race, color, religion, sex, age, national origin, service in the military, disability or sexual orientation.