EmailMe Form - Gaelic Girl

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

### - ### - ####

Date of Birth *

MM / DD / YYYY

Education

University/College *

City/State/Zip code *

Graduating Year *

Major *

Minor (If applicable)

Work Experience

Company Name

Job Title

Dates of Employment

Responsibilities/Duties

Please give a brief outline of your duties within this role

Company Name

Job Title

Dates of Employment

Responsibilities/Duties

Please give a brief outline of your duties within this role

Company Name

Job Title

Dates of Employment

Responsibilities/Duties

Please give a brief outline of your duties within this role

Company Name

Job Title

Dates of Employment

Responsibilities/Duties

Please give a brief outline of your duties within this role

Extra Curriculum Activities

List activities, clubs or societies that you are a member of.

Please give a BRIEF description of your position. *

*Maximum 5 entries please

Placement Preferences

Go to www.GaelicGirl.com for further descriptions.

Program Dates *

Spring 2014

Summer 2014

Please see our website for the upcoming dates

Internship/Volunteer Preference

If Other, please give further details *

Select your second choice

If Other, please give further details *

Select your third choice

If Other, please give further details

Tell us why you would like to do the Gaelic Girl Program.

Between 150 - 300 words, explain why you are interested in the Gaelic Girl Program. *

How did you hear about the Gaelic Girl Program? *