Name:  __________________________________________________________________

Address:  ________________________________________________________________

________________________________________________________________________

Telephone Number: ________________________________

E-Mail: ___________________________________________

School: __________________________________________

Desired dates of internship: Starting ______________  Ending ____________

Will you earn college credit for this internship? Yes ______  No ______

Standing: Junior Senior Graduate Other

What are your goals for your internship? Please list four (4).

_____________________________________________________________________ PLEASE MAIL:

1. Completed Intern Application Form
2. Your College internship requirements
3. Current Résumé
4. Advisor's Letter of Recommendation

TO: Gary Logue, ADA/Inclusion Coordinator
Fairfax County Park Authority
Leisure and Wellness Division
12055 Government Center Parkway, Suite 927
Fairfax, VA 22035-1118