Civic Leaders Internship Program - Intern Request Form

Intern Request Form

Name of Office or Legislator:

District #:

Party Affiliation:

Intern Supervisor Name:

Intern Supervisor Title:

Intern Supervisor Email:

Room Number:

Street Address:

City:

State:

Zip:

Phone:

Fax:

Major Activities or Legislative Priorities of Your Office:

On What Committees do you Anticipate Serving (check all that apply):


LEGISLATIVE COMMITTEES:
Administration & Accounts	Agri-Business
Agriculture Policy	Agriculture, Food Production & Outdoor Resources
Budget	Commerce, Consumer Protection, Energy & Environment
Conservation & Natural Resources	Corrections & Public Institutions
Crime Prevention	Education
Elections	Elementary & Secondary Education
Energy & Environment	Ethics
Financial & Governmental Organizations & Elections	Financial Institutions
Fiscal Review	General Laws
Governmental Accountability & Fiscal Oversight	Health Care Policy
Health, Mental Health, Seniors & Families	Healthcare Transformation
Higher Education	Homeland Security
Insurance Policy	International Trade & Immigration
Job Creation & Economic Development	Jobs, Economic Development & Local Government
Judiciary	Judiciary & Civil & Criminal Jurisprudence
Local Government	Progress & Development
Public Safety	Real ID & Personal Privacy
Retirement	Rules
Rules, Joint Rules, Resolutions & Ethics	Rural Community Development
Senior Citizen Advocacy	Small Business
Small Business, Insurance & Industry	State Parks & Waterways
Tax Reform	Tourism
Transportation	Utilities
Veterans	Veteran's Affairs, Pensions & Urban Affairs
Ways & Means
APPROPRIATIONS COMMITTEES:
Agriculture & Natural Resources	Education
General Administration	Health, Mental Health & Social Services
Public Safety & Corrections	Transportation & Economic Development
SPECIAL STANDING COMMITTEES:
Children & Families	Emerging Issues in Animal Agriculture
General Laws	Health Insurance
Infrastructure & Transportation Funding	Professional Registration & Licensing
Urban Issues	Workforce Development & Workplace Safety
JOINT COMMITTEES:
Administrative Rules	Capital Improvements & Leases Oversight
Corrections	Court Automation
Economic Development, Policy, & Planning	Education
Gaming & Wagering	Government Accountability
Legislative Research	Legislative Research - Oversight Subcommittee
Life Science	Missouri Job Training Joint Legislative Oversight Committee
MO Health Net	Public Employee Retirement
Real Property Tax Increment Allocation Redevelopment	Restructuring Fees of the Clean Water & Storm Water Programs
Restructuring Fees Paid by Hazardous Waste Generators & Facilities	Tax Policy
Terrorism, Bioterrorism, & Homeland Security	Transportation Oversight
Wetlands

Possible Intern Responsiblities (check all that apply):

Research Issues
General Office Duties
Attend Meetings
Track Legislation
District Directory/Survey
Lead tours of the Capitol
Provide Constituent Services
Write Speeches, Newsletters & Press Releases
Support Committee Work
Other:

Preferred Qualifications of Intern (may include a particular major, student from your district, etc.):

We will make every effort to honor your needs and provide an intern to all who request one. Our interns are in high demand and the majority of them are enrolled in part-time internships (8 or 16 hours per week), so it is not always possible to fill all requests.

Will You Accept a Part Time Intern?

Yes
No, Full Time Only

Indicate Amount of Hours Student can Intern (check all that apply):

8
16
35

Indicate Days Intern is Needed (check all that apply):

Monday
Tuesday
Wednesday
Thursday
Friday

I Would Like an Intern During (check all that apply):

August-December (Fall Semester)
January-May (Spring Semester)
June-July (Summer Semester)