1.
CHA STUDENT INTERNSHIP APPLICATION
CONTACT INFORMATION
Date: ___________________________________
First Name: ______________________________ Last Name: ___________________________________
Mailing Address: _________________________________________________________________________
City: _________________________________ State: ______________ Zip: ___________________
Home Telephone Number: ___________________ Cellular Telephone Number: ______________________
Which number do you prefer us to use to contact you? _______________
Fax Number: __________________________ Email Address: ________________________________
HOW DID YOU HEAR ABOUT THE CHA INTERNSHIP PROGRAM?
___Internet: Which site? _________ ___School: Which one? ________ ___ CHA Partnering Organization: Which? ___________
___CHA Public Housing Bulletin ___Media (print, TV, radio) ___ Former/Current CHA Intern
___CHA Employee ___Referred by friend/relative ___Other:_______________________________ (specify)
Qualified CHA residents are encouraged to apply.
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Are you currently a:
Resident of a CHA Housing Development
Recipient of a CHA Housing Choice Voucher (Section 8)
If CHA Housing, which development_________________________________________________________
CHA Client ID Number______________________ CHA Head of Household Name____________________
CHA Internship – 14-Feb-13

2.
EMPLOYMENT
Place of employment (current or most recent): _________________________________________________
Job Title/Description: _____________________________________________________________________
Organization: ____________________________________________________________________________
Location: _____________________________________________________________________________
Month/Year to Month/Year: _____/_____ to _____/_____
Place of employment: ____________________________________________________________________
Job Title/Description: ____________________________________________________________________
Organization: __________________________________________________________________________
Location: _____________________________________________________________________________
Month/Year to Month/Year: _____/_____to _____/_____
EDUCATION & TRAINING
College Current Year Major Date of Completion/ Degree or Certificate
(i.e. fresh., soph) Expected Completion
VOLUNTEER EXPERIENCE
Please list your most recent volunteer experiences:
Activity/Position: ______________________________________________________________________
Organization: _________________________________________________________________________
Location: _____________________________________________________________________________
Month/Year to Month/Year: _____/_____ to _____/_____
CHA Internship – 14-Feb-13

3.
LANGUAGES
Please list any languages, other than English, that you are able to speak fluently, read, or write.
______________________________________________________________________________________
REFERENCES
Please provide two references (preferably at least one former work supervisor) that have known you for at
least two years and are not related to you. Please let your references know that we may contact them.
Name Telephone Number In what capacities do they know you? How long?
____________________________________________________________________________________________________________
Name Telephone Number In what capacities do they know you? How long?
If selected, you must be available to work a 40 hour week.
For Office Use Only:
Interview Date: ________ Hire Date:________
CHA Internship – 14-Feb-13