Today’s Date:

Name:  Student ID #:

Mailing Address: 

City/State/Zip: 

Telephone:      E-mail: 

Please list any volunteer, employment and personal experiences you have had related to working with older adults and their family members:

List any academic courses or other training that you have completed that would be relevant to working with older adults and their family members:

STATEMENT OF INTEREST IN THE “PARTNERSHIP FOR PRODUCTIVE AGING EDUCATION” PROJECT

Please discuss in essay format why you would like to participate in this practicum experience. Limit your discussion to 700 words.  Essays submitted that are longer than the space provided will not be considered.

Be sure to address each of the following:

Why are you interested in working with older adults? What strengths and talents will you bring to the experience? What limitations or areas for further development would you like to work on through your engagement in this project? How will this internship contribute to achievement of your career goals?