Community Techincal Assistance, Inc. (CTA)

Internship Interest Form

Question Title

* 1. What is your contact information?

First Name *

Last Name *

Address *

(Apartment #)

City/Town *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

Question Title

* 2. What is your preferred method of communication? (Check all that apply)

Email

Call

Text Message

Question Title

* 3. The following are duties & responsibilities Including, but not limited to:
1. Research & Data Gathering
2. Marketing Development & Organizational Branding
3. Website Management
4. Planning & Organizing for Community Events

Do you agree with the list of duties & responsibilities listed above?

Agree

Disagree