Full Name*:

Nick Name:

Phone Number*:

Email Address*:

Home Address

Street Address*:

City*:

State/Province*:

Zip/Postal Code*:

Country*:

Mailing Address
*If different than Home Address.

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Parent's Names and a text number (in case of emergency):

Skills you bring to the internship:

Skills you want to develop over the next five years:

Skills you want to learn during your internship:

Describe yourself:

I am cheerful

I am good in a crisis

I am patient with others

I enjoy a crowd of people

I enjoy the outdoors

I am good at goal setting

I am good at meeting deadlines

I like to cook

Alone time is vital for my mental health

Usually I go to bed early

I am okay with being ready to meet the day by 7:30 am

Tattoos are cool

Not accessing my phone while working doesn’t bother me

Politics is about life, not a political party

I am fine with not eating meat

I have allergies - describe them

I am lactose intolerant

Showering outside wouldn’t bother me

If you play a musical instrument - which one?

Describe any medications you take regularly and for what reason:

How did you hear about Blue Rock Station?

When would you like to arrive and depart?

I read the internship materials on the Blue Rock Station website and I understand the risks inherent with farm life.*

Anything else we should know about you or your family?