Asian American Youth Council of Dayton (AAYCD)

Intern Application

Name                                                                                                                                                                                                           

Address                                                                                                                                                                     

City                                                                              State                            Zip code                                           

Phone (            )                                     Cell Phone_________________________________________

 E-mail                                                                                                           

Ethnicity                                                          Gender (circle)     Male           Female

High School                                                                                 Grade                             Age                    

Are you a non-smoker?   Yes             No

During the past school year, were you ever placed on academic probation?   Yes                No

Which best describes your experience with this group: (check one)                                       

______ AAYCD Intern (1 year)                    ______ AAYCD Intern (2 years)     

______ AAYCD General Member              ______ Just Learned About AAYCD

I am interested in participating in AAYCD as a:  (check one)

______  Paid Intern    (if funded)                               ______ Volunteer (Unpaid) Intern

NOTE: Funding for the paid intern positions is not totally in place at this time. 

Complete the following questions.

1. How did you hear about us?

__ Friends __ Parents __ Relatives __School  __Newspaper __ Flyers

__ Other, specify:__________________

2. What factors contributed to your decision to become involved in AAYCD?

3. List 2 things you hope to accomplish by being involved in AAYCD.

1.

2.

4. Skills and Talents: (check all that apply)

 __Music __Writing __ Sports __Computers/Technology __Performing Arts

 __ Arts/Design __ Public Speaking __ Other __________________________

5. Describe the Asian community organizations, events, activities you know about and may have participated in during the past 2 years.

6. Pick 1 of the questions below and write a response. Answers should be between 50-100 words.

1. Why is it important to educate the community about the dangers of tobacco use and secondhand smoke?

b.   One in ten Asians is a hepatitis B carrier without even knowing it.  How would you propose alerting and educating the Asian community about hepatitis B?

7. Mail, fax or deliver a copy of this application form with a letter of recommendation from an adult (not related to you) to the  address listed below.

AAYCD, c/o Betty Lacey, P.O.Box 751512, Dayton, Ohio 45475-1512

Fax: 937-439-1700

Re-applying interns do not need to submit a letter of recommendation.

DEADLINE FOR APPLICATIONS:  December 15, 2009

For more information, direct inquiries to: Betty Lacey, 937-239-8577 or aaycd@att.net