Planned Parenthood Santa Barbara, Ventura and San Luis Obispo Counties

INTERNSHIP ENROLLMENT

As part of our Planned Parenthood volunteer team you can become part of something you believe in. The information on this form will help us find the most satisfying and appropriate internship service for you.

Name		Date
Address		City/State/Zip
Home Phone		Email Address
Are you over 18 years of age?	YES NO	If NO, what is your date of birth?
Current Employer		Job Duties

Have you ever served as an intern in a public or a private agency? Yes No
If so, where & when?

How did you first learn of Planned Parenthood?

Why are you interested in interning at Planned Parenthood?

What is your feeling about contraception for minors or unmarried women?

What is your feeling about abortion?

Special skills or services you'd like to offer (i.e. language fluency, computer skills, art):

Times you have available to volunteer: (days & hours)

References: (Give 2 and list their relationship to you. Please do not list family members.)

Name	Phone Number
Name	Phone Number