application

CANADIAN PARLIAMENT
INTERNSHIP PROGRAM
APPLICATION

Dr. James T. Baker
Post Office Box 1641
Bowling Green, KY 42102-1641
Tel: 270-745-5741
FAX: 270-745-2950
E-mail: james.baker@wku.edu

PLEASE PRINT NEATLY OR TYPE.
ANSWER ALL QUESTIONS AND INITIAL IN ALL SPACES PROVIDED.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED AND APPLICATION FEE WILL NOT BE REFUNDED.

1. Full legal name _____________________________   _____________________   ________________________
                          First                                                     Middle (not just initial)      Last

Birth name, if different from above: ___________________   _____________   ___________________________
                                                         First                                 Middle                  Last

Student ID # ___________________________________ Social Security # _______________________________

I would like for you to call me (or) my nick name is _________________________________________________

2. City, State, Country of Birth __________________________________________________________________

Country of my Present Citizenship _________________________________ Date of Birth _________________

3. University or college I attend:_________________________________________________________________

My adviser's name: ____________________________________________________________________________

Adviser e-mail ________________________________________________________________________________

Name and e-mail of person who will be the professor of record for my Internship credit if not the above:

________________________________________________/_____________________________________________

4. My mailing address at school _________________________________________________________________

_____________________________________________________________________________________________

City, State & Zip at school ______________________________________________________________________

Telephone number at school / cell phone ________________________________________________________

E-mail at school ______________________________________________________________________________

E-mail I use regularly and will have throughout the Internship:

_____________________________________________________________________________________________

5. My Parents' Name(s): ________________________________________________________________________

Parent('s)s' Address: ___________________________________________________________________________

City, State, & Zip _______________________________________________________________________________

Telephone at home __________________________ E-mail at home ____________________________________

6. Major __________________________________________________ Major GPA ______ Overall GPA _______

7. Status at the end of this school year - Circle one:    Sophomore    Junior    Senior    Graduate

8. Other languages, other than English, that I speak fluently ________________________________________

9. Approximate speed at using a computer keyboard. ____________/words per minute

10. Experience I have had with computers/word processing ________________________________________

____________________________________________________________________________________________

11. My vocational goals: _______________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

12. My community, social, and recreational interests: ______________________________________________

____________________________________________________________________________________________

13. The skills I possess that will be helpful to me and the Parliament as an intern: _____________________

____________________________________________________________________________________________

____________________________________________________________________________________________

14. My recent work experiences, both paid and volunteer work: ____________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

15. My major scholastic honors and achievements: ________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

* IF YOU HAVE A BRIEF RESUME, PLEASE INCLUDE IT WITH YOUR APPLICATION *

16. I can work with any of the Canadian political parties. Check here _____ if applicable -
best option if you have no strong preference, or feel you do not know the parties well,
**OR**
I would definitely like to be placed with the _____________________________________ Party.

17. I consider myself, by U.S. standards, Liberal __ Moderate __ Conservative __ (Check only one)

18. The field of government and/or Canadian culture that interests me most:

____________________________________________________________________________________________

19. Check One - I prefer to be placed in an Anglophone ______ Francophone ______ office.

20. **REQUIRED**: I am including a brief sample of my writing. Initial here:_______
A class research paper or essay will serve this purpose.
Do NOT send one that is more than three pages in length.
DO send one that shows your language and composition skills.
If you want to work in a Francophone office, please send one in French.

Topic: ________________________________________________________________________

21. **REQUIRED**: I am including a letter of recommendation from an instructor or employer. Initial here:_______

Person’s name, position, and e-mail ____________________________________________________________

____________________________________________________________________________________________

**REQUIRED** Initial EACH of the following statements on the space provided to show that you DO agree with all statements.

22. ** REQUIRED** I am enclosing a check for $100.00 U.S. _______.
Make check payable to Canadian Parliamentary Internship Program.
Your check will be cashed only if Dr. Baker feels he can place you.

23. I understand that this $100.00 is required to apply, and that it is nonrefundable: _______.

24. I understand that another $1700.00 U.S., for a total of the full $1800.00 cost of the program, is due WHEN I AM NOTIFIED of
my placement _______.

25. I understand that if I withdraw from the program, for whatever reason, the part of the $1800.00 that has, at that time, been
paid for my housing and other costs of the program will NOT be refundable, and that Dr. Baker, and he alone, will determine
the amount of the reimbursement, if any _______.

26. I agree to fulfill to the best of my ability all requirements of the program given to me by the director and the office to
which I am assigned _______.

27. I understand that Dr. Baker will not be physically present at every moment during the internship program, and thus I will
conduct myself as a responsible adult during the course of this program, both at work and in my social activities ______.

28. I fully understand that I must pay for the program AS SOON AS I am billed. I further understand that I will NOT be given
time to arrange funding after billing has gone out, I am NOT depending upon possible grants and/or scholarships which my
school might provide me with funding, and I AM budgeting enough funds for my transportation to and from Ottawa and for
my food and incidentals while in residence ______.

29. I agree that in order to avoid interpersonal problems, I will not smoke anywhere on the floor where my fellow interns live
_______.

30. I understand that the residence is for professional people, not a college dormitory, and thus I will strictly observe quiet
hours between 10 p.m. and 6 a.m. EACH AND EVERY night _______.

31. I have the following special medical requirements: _____________________________________________________________
**OR** Initial here if you have no special medical requirements:__________
**AND** I agree to be responsible for all of my own medical needs and considerations throughout the program _______.

32. I have the financial resources and/or an international insurance policy to handle any medical needs I may face during the
program _______.

33. I agree that I will not hold Dr. James T. Baker or the Canadian Parliamentary Internship Program responsible for any injury
or illness I may experience while traveling to, participating in, or making my way home from the program _______.

36. I am enclosing the required 2 x 3 inch recent snapshot of myself _______.

37. Because the Canadian Security Service will check my records, I herein state that I have NO criminal offence on my record
that will prevent my being cleared for Internship in Parliament _______.

38. Check One: I have (___), will have (___) a current passport in May for travel to and from Canada _______.

39. I agree that I will arrive on time and will remain in Canada throughout the entire program, which begins in May and runs
through June, and that once I am accepted into the program, confirmed by a call from Dr. Baker, I will not consider any other
program or course of study that runs concurrent or overlaps the time of the internship _______.

Send this Completed & Notarized form to:

Dr. James T. Baker
Parliamentary Internship Program
Post office Box 1641
Bowling Green, KY 42102-1641

Sign before a Notary Public:

I have personally read, completed correctly to the best of my ability, and have personally initialed where required, ALL of the
above, and agree to all terms and conditions within as witnessed by my signature this day before a Notary Public:

Printed Name: ________________________ Signature: ______________________________ Date: __________

If you are not yet 21 years of age at the time you are filling out this form, you MUST have your parent or guardian read your
application and sign the following statement before a Notary Public:

I have read, and I approve all items above for my child as witnessed by my signature this day:

Signature _____________________________________________________________ Date _________________

Relationship to the intern _____________________________________________________________________

NOTARY PUBLIC:

Sworn and Subscribed before me on this day:_____________ My commission expires: __________________

Notary Public Signature & Stamp:________________________________________________________________