The Center for Interim Programs - Post Career Application

Post-Career Application

Please fill out the online application form below and click 'Submit'. NOTE: Fields marked with an asterisk (*) are required.

If you prefer, click right on the following link to download and save the application which you can fill out in your word processor (e.g., MS WORD)and save. Then print and mail or FAX the completed form to us, or email the completed and saved file to info@interimprograms.com. You may also use your PC's printer from your web browser to print the text version of the application which you can fill out by hand and return to one of our offices by FAX or mail.

Date	Age	Birthdate
First Name*	Last Name*	Male	Female
Nickname	Address*
City*	State*	Zip*		For Office Use Only - Please Leave Blank

Home Phone* Cell Phone Office Phone Email
High School	Graduation Year
College	Graduation Year
Post Graduate Work	Graduation Year
Relative First Name	Relative Last Name	Relative Phone
Other Contact First	Other Contact Last	Other Contact Phone

Your Former Occupation	Business Information

How did you hear about Interim?

When would you like to start?

What work and/or volunteer positions have you held?

What other programs have you already attended?

Where have you traveled in the U.S. and abroad?

What languages have you studied and for how long?

Do you have any physical, psychological or medical conditions that might affect your participation?
Are you currently taking any medications?

Check those categories below that help to define your interests.

Geographic Location:

Africa	Japan	Germany	Oceania	Costa Rica	Chile
Ghana	Nepal	Ireland	Australia	Guatemala	Canada
Tanzania	Tibet	Greece	New Zealand	Mexico	United States
South Africa	Turkey	Italy	Fiji	South America	Hawaii
Asia	Europe	Spain	Micronesia	Brazil	Alaska
China	England	Russia	Central America	Bolivia	Middle East
India	France	Eastern Europe	Caribbean	Ecuador	Israel
Other

Areas of Interest:

Indoor

Outdoor

Urban

Rural

Academic

Non-academic

Agriculture	Construction	Horses	Outdoor Edu.	Social Service
Animals	Cooking	Hotel Mgmt.	Painting	Spiritual
Anthropology	Cultural Study	Jewelry/Metal	Photography	Sports
Archaeology	Dance	Journalism	Politics	Teaching
Architecture	Design/Graphics	Kids	Radio	Theater
Art & Crafts	Drawing	Languages	Ranching	Wilderness
Blacksmithing	Environment	Native American	Recording Arts	Woodcraft
Business	Fashion	Marine Biology	Sailing	Writing
Canoe/Kayak	Field Research	Marine Mammals	School Internship	Video/T.V.
Ceramics	Film	Medical	SCUBA	Yoga/Meditation
Computers	Forestry	Museum	Sculpture	Zoo/Aquarium
Conservation	Glasswork	Music	Skiing	Other

If you could wave a magic wand, what would you do with your Interim time?

Please send us a recent photo by mail, or send a URL where we can find your picture.