2010 Regional Internship Program for Myanmar Nationals - Intake #1

Application Form - January 2010

Please complete and return this form and all relevant documents by March 12, 2010
For application instructions, please refer to the "2010 Internship Overview", or visit www.internshipsasia.org.
Questions/Comments about this program or the application process? E-mail apply@internshipsasia.org.

Personal Information How Did You Hear About This Program?

MALE FEMALE Internet Faculty Member

FULL NAME: Friend or Relative E-Mail from IA
Other (Please Specify)
OTHER NAMES:
Please Specify

PLACE OF BIRTH
Diversity Survey (optional)
Village/City State/Province Country RELIGION:
ETHNICITY:
DATE OF BIRTH
Day Month Year
Disability Survey (optional)
PERMANENT ADDRESS FOR YOUR PARENTS OR GUARDIANS
DO YOU HAVE ANY CHRONIC PHYSICAL OR
Street: MENTAL HEALTH ISSUES?
Village/City: Yes* No
State: Country: *If YES, please describe your health issue, as well as any
services or medicines you require. This information will be
Postal Code: kept confidential and used solely for planning purposes.

Telephone:
Country Code Area Code Phone Number

YOUR CURRENT ADDRESS Other Contact Information

Until MOBILE TELEPHONE
Month Year

Street: Country Code Area Code Phone Number

Village/City: E-MAIL ADDRESSES

State: Country: Primary:

Postal Code: Secondary:
Telephone:
Country Code Area Code Phone Number
Emergency Contact Information
DO YOU HAVE A VALID PASSPORT? Please provide us with information on who to
contact in the event you are seriously ill or injured.
Yes*
Expiration Date Name
No
I have applied, and I expect to receive it by: Relationship
Month
Telephone:
*Along with this completed application, please provide us with an Country Code Area Code Phone Number
electronic copy of the photo page of your passport (if available).
E-Mail:

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 2010 Intern Application for: 2 of 7

You and Your Home Organization

In order to participate in IA's Regional Internship Program, you must be currently working or volunteering with a development
organization (preferably) in Myanmar. In this section, you can tell us about your organization, and whether you have support to
participate in this program.

Organization Name:
Type of Position
Country Location:
Your Job Title:

List your responsibilities within the organization, duties performed, skills used, advancements, or promotions received:

(1) Have you discussed this program with your supervisor or the senior staff of your organization? Yes No
Supervisor's Name: Supervisor's E-Mail:

(2) Do you have a letter of support from your organization that's required to participate in the program? Yes No
(3) Do you have specific projects on which to work when you have completed your internship? Yes* No
* If YES, we strongly encourage you to describe your plans within essay #3 of this application

Your General Areas of Interest

In order for us to get to know you better, please select three choices from the options below that interest you the most. Please
number your selections in order of preference: 1, 2, 3, indicating your first, second and third choices.

-- ADVOCACY -- ENVIRONMENT & ECOLOGY -- LAW & LEGAL ASSISTANCE

-- COMMUNITY ART, MUSIC

-- GENDER & SEXUALITY -- RURAL DEVELOPMENT
& THEATRE

-- CORRUPTION -- HEALTH PROMOTION -- YOUTH & FAMILY

-- INDIGENOUS PEOPLE
-- DISABILITY ISSUES -- OTHER:
& CULTURE
-- INFORMATION TECHNOLOGY
-- EDUCATION
FOR DEVELOPMENT
(please specify)

Advertised Placement for Which You are Applying

The Regional Internship Program has been redesigned so you can directly apply for specific internship opportunities we advertise
for each intake of the program. If you haven't already done so, go online to www.internshipsasia.org to review all the available
placements where you could intern during this intake. In the spaces below, please outline your internship preferences as they
relate to positions on the IA website. This section must be completed by all applicants.

If you do not see a position that interests you, please contact us to learn what plans we may have for advertising future
placements in your area of interest.

Please write the name of your preferred placement here:

(1) First Placement Preference*

*The content of your application should reflect this preference - especially within the content of your essays.

(2) Second Placement Preference

Internships Asia - P.O. Box 130, Mae Ping Post Office, A. Muang, Chiang Mai, Thailand, 50301 - www.internshipsasia.org - apply@internshipsasia.org 2 of 7
 2010 Intern Application for: 3 of 7

Educational Attainment

Select the Highest Level of Formal Education You Have Attained:

PLEASE LIST THE THREE (3) MOST RECENT EDUCATIONAL INSTITUTIONS YOU ATTENDED (most recent first)
Submit copies of your grade transcripts or certificates along with this form. These documents may be mailed separately by
post if unavailable in an electronic form.

1) Name of Institution: Type of School:

Country Location:

Dates Attended: to
Month Year Month Year

Subjects/Majors Studied: Degree or Certificate:

2) Name of Institution: Type of School:

Country Location:

Dates Attended: to
Month Year Month Year

Subjects/Majors Studied: Degree or Certificate:

3) Name of Institution: Type of School:

Country Location:

Dates Attended: to
Month Year Month Year

Subjects/Majors Studied: Degree or Certificate:

DO YOU PLAN TO APPLY FOR UNIVERSITY/COLLEGE SCHOLARSHIPS?

No.
Maybe. I might apply for scholarships in the next few years.
Yes. I plan to apply for scholarships during or immediately after the completion of an internship.
Yes. I have already applied to:

TRAINING SEMINARS & WORKSHOPS RELATED TO YOUR FIELD(S) OF INTEREST

Please list the 5 most RELEVANT trainings you attended. DO NOT send any copies of certificates with your application.
Name of Training or Workshop Training Organization Year Duration Certificate Received
1:

2:

3:

4:

5:

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Language Proficiency
PLEASE INDICATE YOUR PROFICIENCY IN ALL LANGUAGES YOU KNOW (please include ethnic or national languages)

Proficiency Key: 1=Basic Knowledge; 2=Proficient; 3=Fluent; 4=Native Language

Language Speaking Reading Writing Comprehension
English (Required)

Other Work Experience

PLEASE LIST UP TO THREE (3) OTHER POSITIONS OF EMPLOYMENT, INTERNSHIPS, OR VOLUNTEER PROJECTS (most recent first)
If you have held more than 3 positions, you are free to attach a CV or resume to exhibit your experience.

1) Name of Institution: Type of Position

Country Location:
Position Last Held:
Monthly Income:
Dates Worked: to Local Currency:
Month Year Month Year

List the jobs you held, duties performed, skills used or learned, advancements, or promotions received:

Reason for Leaving:

2) Name of Institution: Type of Position

Country Location:
Position Last Held:
Monthly Income:
Dates Worked: to Local Currency:
Month Year Month Year

List the jobs you held, duties performed, skills used or learned, advancements, or promotions received:

Reason for Leaving:

3) Name of Institution: Type of Position

Country Location:
Position Last Held:
Monthly Income:
Dates Worked: to Local Currency:
Month Year Month Year

List the jobs you held, duties performed, skills used or learned, advancements, or promotions received:

Reason for Leaving:

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 2010 Intern Application for: 5 of 7

Essays

1) BIOGRAPHICAL ESSAY
In approximately 600 words (typed in the space below, and written in English), please answer the following question to the best
of your ability. It may be helpful to initially write your essay with a word processing program because this will allow you to copy
and paste the completed essay into the space below.
Please describe your personal history as it relates to your interest in this program.

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 2010 Intern Application for: 6 of 7

Essays (continued)
In approximately 250 words each (typed in the space below, and written in English), please answer the following questions to the
best of your ability.
2) AREAS OF INTEREST
How do you believe securing your first placement choice for an internship can help develop your skills and knowledge in
your field of interest?

You wrote that your first placement choice is:

3) FUTURE PLANS
After successfully completing an internship, what plans do and your home organization have to utilize the skills and
knowledge you expect to gain through this program?

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 2010 Intern Application for: 7 of 7

Miscellaneous Information (optional)

If you have any additional information you feel is relevant to your application, feel free to use the space provided.

Agreements and Confidentiality

All information collected by Internships Asia will remain highly confidential, and used exclusively for internship
placements.
Please read below and sign if you consent to the following:

"I certify that the above information is correct. I understand that all of the credentials
submitted in support of my application to IA will become property of IA and are not
returnable to me. I authorize IA to share my application, recommendations, and transcript
(s) with potential internship hosts, otherwise all information will remain confidential. I
further understand that, if accepted into the program, I will provide any additional
information required to facilitate placement with a host organization".

Type Full Name Here: Date:

Locale: en_AU Version: 2.5.6290.0

Application Checklist
Please submit the following documents by March 12, 2010 to Application Deadline:
apply@internshipsasia.org. A postal address is available for you in
the event you cannot electronically submit some documents. To March 12, 2010
expedite the processing of your application PLEASE ONLY SUBMIT
THE FOLLOWING DOCUMENTS:

Completed application form For application materials you cannot submit

electronically, please send by postal mail to:
Completed essays
Letter of recommendation from your home organization Enrollment Services
Internships Asia
Letter of recommendation from a past employer, etc
P.O. Box 130
Copy of passport or travel documents (if available) Mae Ping Post Office
Copies of educational grade transcripts A. Muang Chiang Mai, 50301
Copies of language test scores (if available) Thailand

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