City of Lynchburg

catherine.henry@lynchburgva.gov

(434) 455-3936

Internship Volunteer Application

Thank you for your interest in volunteering for the City of Lynchburg! Internships are at the discretion of the City department. Your application will be forwarded to the appropriate department for consideration.

Please complete the following information and then click submit.

NOTE: COURT ORDERED COMMUNITY SERVICE IS NOT ACCEPTED FOR AN INTERNSHIP.

Today's Date

Primary Phone Number

Secondary Phone Number

Age Range

19 - 30

30 - 50

Over 50

During which hours are you available for volunteer assignments?

Weekday Mornings

Weekday Afternoons

Weekday Evenings

Weekend Mornings

Weekend Afternoons

Weekend Evenings

What type of internship?

Internship (High School)

Internship (College)

About how many hours can you volunteer?

Weekly: 2-10 hours

Weekly: more than 10 hours

Monthly: 2-10 hours

Monthly: more than 10 hours

Are you volunteering to satisfy an education requirement?

Yes

Highest level of education completed:

Indicate which areas you are interested in volunteering.

Administration

Parks & Recreation

Library

Museums

Public Works/Engineering

Water Resources

Work experience (please summarize):

Physical limitations if any:

Special skills or qualifications:

Previous volunteer experience:

Please provide two references (name, phone and/or email and relationship).

Person to notify in case of emergency:

Primary Phone Number

Secondary Phone Number

Agreement and Signature (if under 18 years of age, a Parent or Guardian must sign)

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. It is also understood that depending on the type of volunteer service I am selected for, a background check may be performed.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.