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APPLICATION FOR ROSENBERG INTERNSHIP PROGRAM
CONTACT INFORMATION
1. Name (first, middle, last)_______________________________________
2. Date of birth (month/day/year) __________________________________
3. Current Mailing address:
_________________________________
_________________________________
4. Cell phone number:
__________________________________
5. Email address:
___________________________________
6. Home address (permanent): ___________________________________
___________________________________
7. Home telephone number:
___________________________________
EDUCATION
8. Are you currently enrolled and in good standing at an accredited undergraduate or
graduate program? ___________
If so, please provide the name of the institution, its address, your major and
current GPA. Please attach a copy of your most recent transcript, as well as a list
of courses you are currently taking.
9. Undergraduate Education: Please list all institutions attended, with the current
and most recent first. Please provide the name of the institution, its address, your
major and GPA, and the dates you were enrolled there. Use additional sheets if
necessary.
10. Expected date of Graduation:______________________
11. Post-graduate education or plans (if applicable):
12. High School Education: Please provide the name of your high school, its address,
and the dates you were enrolled there:
INTERNSHIP INFORMATION
13. Organization where you will intern:
a. Address: ________________________________________
________________________________________
b. Website address for organization: _____________________
c. Contact information for internship supervision at organization:
14. Dates of your internship: __________________________________
15. Attach a brief (1-3 page) statement regarding your internship, how it will advance
your knowledge of matters directly related to the Foundation’s mission, how you
will use that knowledge gained to impact others, and how you anticipate sharing
what you’ve learned through this experience with others, both in the short-term
and long-term.
16. Attach a detailed budget, including living and transportation expenses, if
applicable.
OTHER INFORMATION
Citizenship: U.S. ___ U.S. Permanent Resident visa ___
Other: __________________________________________
Please indicate if you are related to any member of the Board of the Justus &
Karin Rosenberg Foundation, any member of its staff, or any substantial
contributor to the Foundation: YES________ NO __________
How did you learn about the Rosenberg Internship program?
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
REPRESENTATIONS
The Foundation views it as a critical component of its own mission and of the value of
this Program to enhance collaboration among the diverse groups working to reduce
antisemitism and to share information, experience and ideas that will lead to the
development of knowledge and best practices that will limit the growth of hatred and
antisemitism. Accordingly, as a condition of your participation in the Program, we
require your commitment to:
1. share your experiences with the Program and what you have learned with students
who participate in this program in subsequent years, both in an informal (one on
one meetings and through email and phone conversations) and formal
(participation in presentations and panels) setting.
2. submit, within three months of the completion of your internship, a writing (1250
words minimum) developed under the supervision of the Foundation’s Executive
Director, that either a) describes the work undertaken during the internship and
how it contributes to the field, or b) based on work undertaken during the
internship, makes a contribution to the literature in the field (such as an analysis
with policy recommendations)
By signing below, I certify that all of the information I have presented herein is true and
correct, and I agree to the representations above.
_____________________________
Name printed
___________________________
Date
_____________________________
Signature
COMPLETED APPLICATIONS CAN BE EMAILED TO
KEN@JKRFOUNDATION.ORG, OR MAILED TO THE FOUNDATION AT POST
OFFICE BOX 170, BROOKLYN NY 11218