DLIR Volunteer Internship Program (V.I.P.) Intern Request Form

First Name: M.I. Last Name:
Phone No: E-mail Address:
Fax No (if applicable):
Re-enter E-Mail Address:
City: State: Zip:
Registered in HireNet Hawaii? Yes No
What type of internship position are you interested in?
   1st Choice  
   2nd Choice
What type of businesses are you interested in (if any)?
When are you available for internship: hours per week (eg. 8:00AM to 4:30PM, M-F)?