Application Deadline: New applicant – April 22nd, 2022

Summer Nature & History Intern ApplicationPlease submit entire application (Intern Application & PRCS pages and 3 Letters of Reference)to: Claude Moore Park, Attn: Brian Danner, 21544 Old Vestal’s Gap Road, Sterling, VA 20174or email to brian.danner@loudoun.gov Questions? Call 571-258-3700

Name_____________________________________ 2022-2023 Grade & School__________________________Address___________________________________________________________________________________City/State_________________________________________ Zip code___________________________Phone: Home:_____________________________ Cell: _____________________________________ Email:_____________________________________________________________________________________

Parent Name:_________________________________________ Phone: Home:_________________________Cell:_______________________________ Email: _________________________________________________

What would make this internship successful for you? What are you looking to have learned by the time you’ve completed the internship? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List any school activities, scouts, church or community programs you are currently involved in (sports, clubs, etc.) and/orany awards you have received. ______________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you attended any nature/outdoor or history programs? (E.g. Scout camp, nature camp, family camping at state or national parks, visiting historic sites, participating in reenactments, etc.)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Briefly describe any work or volunteer experiences you have had. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List other hobbies, talents and interests or additional information about yourself that you think pertain to this internship._________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are there times you will be on vacation or not available that you are currently aware of? If yes, when? ____________________________________________________________________________________________________________________________________________________________________________________

We have t-shirts made for the interns to wear over the summer. Please indicate the size you would like.__________________________________________________________________________________________

Please Check Areas ofInterest Interest

Have Some Experience

Please Check Areas ofInterest Interest

Have Some Experience

Exploring nature Working with children

-Wildlife Arts & crafts

-Plants Puppetry/acting

-Geology Singing &/or playing an instrument with campers

Hiking Photography

Fishing Storytelling or writing

Caring for park animals Historic reenactment

Habitat stewardship projects History/Genealogy research

Creating displays Archaeology

Any special interest not listed?

NEW Applicants: Please submit three letters of reference with your application. These may be from a teacher, neighbor, clergy person, scout leader, employer or other adult who knows you. Letters may be emailed to brian.danner@loudoun.gov.

As a Summer Nature & History Intern I agree to abide by the following Code of Conduct:

I promise that as a representative of the Loudoun County Department of Parks, Recreation and Community Services my words and actions will conform to the high standards set for all employees of the county.

I promise to carry out my responsibilities in a conscientious and professional manner. I promise to be a team player, working with and supporting the Park staff and other volunteers. I promise to be prompt to training and assigned activities and will notify the Park office when I must be absent

or tardy.

I promise to abide by all guidelines of this program and the Park. I promise to follow directions as given. I will ask questions of the appropriate staff member if I do not fully

understand the assignment.

I promise to act with safety as my highest priority.

Applicant’s Signature _______________________________________________Date_____________

Parents/Guardians:I have read the accompanying information, including the Code of Conduct and agree to have my child participate in this program. I will arrange transportation for my child and make sure that he/she arrives and is picked up promptly. Also, bysigning below I give permission for Loudoun County PRCS to use photographs and videos of my child for publicity in order to increase community awareness of PRCS programs and in all publications and media without limitation.

Are there any medical conditions or allergies the Park staff should be made aware of? Yes____ No_____If yes please specify _________________________________________________________________________________

Parent/Guardian Signature __________________________________________ Date_____________

NOTE: Due to limited space all parts of the application must be received by the deadline for the applicant to be considered.

Upon acceptance into the program, the Intern will receive a family membership to the Friends of Claude Moore Park. The membership will be good for the year with the option to renew at the end. To learn more about the Friends of Claude Moore Park, check out their website at https://friendsofclaudemoorepark.org/If you would prefer not to become a member, please opt out by checking the box below.