Fillable Student Volunteer Application (U.S. Copyright Office)

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Student Volunteer Application (U.S. Copyright Office)

On average this form takes 13 minutes to complete

The Student Volunteer Application (U.S. Copyright Office) form is 2 pages long and contains:

  • 3 signatures
  • 7 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

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Student/Volunteer Information
Full Name:
Street Address:
City: State: Zip Code:
Home Phone: Cell Phone:
E-mail Address:
School Name:
Major: G.P.A.:
Program Level: High School Junior/Community College Undergraduate College/University Graduate/Law School
Expected Completion Date/Degree:
UNITED STATES COPYRIGHT OFFICE
5
Student Volunteer Application
ADMINISTRATIVE
SERVICES OFFICE
Availability
Which quarter/semester are you available for assignments?
Earliest Available Date: Preferred Ending Date:
Which Weekdays: Specify Hours:
What will you receive for services?: Academic Credit Student Service Learning (SSL) Hours Training/Experience
Special Skills or Qualications
Summarize special skills and qualications you have acquired from employment, previous volunteer work, or through other
activities, including clubs or sports teams.
Previous Experience
Summarize your previous employment and volunteer experience.
PAGE 
Person to Notify in Case of Emergency
Name:
Relationship to Student:
Street Address:
City: State: Zip Code:
Home Phone: Cell Phone:
Work Phone:
E-mail Address:
Student/Volunteer Agreement and Signature
By submitting this application, I arm that the facts set forth in it are true and complete. I understand that if I am accepted as an
intern/volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my
immediate dismissal.
Student Signature: Date:
If under 18 years of age, a parent/guardian’s signature is required.
Parent/Guardian’s Signature: Date:
Parent/Guardian’s Name:
School Agreement and Signature
By signing this application, I arm that this student meets the eligibility requirements of a 3.0 G.P.A. and is in good standing with the
school or college/university. I hereby refer this student to the U.S. Copyright Oce Internship/Volunteer Program.
Signature: Date:
Name:
Position:
Our policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual
preference, age, or disability.
U.S. Copyright Oce phone: (202) 707-8370
Administrative Services Oce fax: (202) 252-3668
101 Independence Avenue, SE, LM 458 email: copyrightinternships@loc.gov
Washington, DC 20540 website: copyright.gov
REVISED
:
 ⁄ 
PAGE 
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Student Volunteer Application (U.S. Copyright Office)

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Completed 16 July 2020

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