2000 EXXON COMMUNITY SUMMER JOBS PROGRAM (CSJP)



EXXONMOBIL

COMMUNITY SUMMER JOBS PROGRAM (CSJP)

AGENCY APPLICATON

Please review the accompanying Program Guidelines before you begin to complete this application. We also suggest that you do a quick overview of the application before proceeding.

In order to be considered for funding, your agency must be a 501(c)(3) Non-Profit Organization or Governmental Agency located in Harris County.

Your agency’s application must also be:

• Signed by the Executive Director

1. Received at Volunteer Houston by Friday, December 6 at Noon

Applications can be downloaded at , filled in on the computer and then printed out for submission.

Applications (and accompanying materials) must be mailed or delivered to:

Laura Meares

Volunteer Houston

3015 Richmond, Suite 100

Houston, TX 77098

FAXED OR EMAILED APPLICATIONS WILL NOT BE ACCEPTED

General Information

Name of Agency:      

(Please list the way it should appear in printed/publicity materials)

Legal Name (if different):      

Agency Mission Statement:      

Agency Street Address:      

Agency City:       State:       Zip Code:       County:      

Telephone Number:       Fax:      

Agency Website:      

Agency E-mail Address:      

Name of Executive Director:      

Intern Supervisor’s Name:      

Intern Supervisor’s Title:      

Intern Supervisor’s Street Address, City, State and Zip (if different from agency address):      

Intern Supervisor’s Phone:       Extension:      

Intern Supervisor’s Email Address:      

Is the Intern Supervisor a paid employee of the agency?

If yes, what is the Intern Supervisor’s employment status?

How long has the Intern Supervisor been employed by the agency?      

If someone other than the Executive Director or the Intern Supervisor will handle recruitment and hiring for the intern, please list that person’s:

Name:      

Title:      

Phone:       Ext:      

Email Address:      

Select the one category that best reflects your agency’s mission:

If “Other,” please explain:      

Select the one employment category that best reflects the internship:

If “Other,” please explain:      

Estimate the populations served by your agency (give percentages):

Ethnicities: African-American       Anglo       Asian      

Hispanic       Native American       Other      

Ages: 0 – 17       18 – 29      

30 – 65       65 +      

Genders: Female       Male      

Identify the number of staff members employed by your agency:

Full-time:       Part-time:      

Internship Information

What would be the intern’s job title?      

Briefly describe the internship in 2-3 sentences:      

Summarize the intern’s job responsibilities with an attached job description. Include a detailed description of the program, project or area for which the intern will have primary responsibility and a full explanation of the intern’s role and duties.

Identify the preferred schedule for the internship (35 hours per week for an 8-week period).

The 8-weeks must begin on or after June 1, must end by August 31 and the weeks must be consecutive.

Preferred internship start date:       Preferred internship end date:      

Workdays each week:       Hours of each workday:      

Describe how you would recruit an intern:      

Outline some of the skills a college student would learn or develop through this internship:

Technical Skills:      

Professional / Communication Skills:      

Management / Administrative Skills:      

Other Skills or Competencies:      

Experience has shown that the most valuable internship includes a thorough and complete intern orientation to the overall work of the nonprofit agency. Please check the elements that would be included in your orientation:

Presentation of agency’s history, mission and goals

Personal introductions to agency staff members

Opportunity for interaction with volunteers

Opportunity for interaction with clients/patients/patrons

One-on-one time with the agency executive director

Opportunity to attend an agency board meeting

Presentation of agency budgeting/fundraising processes

Tour of agency facilities

Explanation of payroll process (including tax withholding)

Overview of office procedures (expense reporting, mail, etc.)

Intern will be provided with his/her own desk/office/workspace

Intern will be provided with a computer (if required for job)

Supervisor will clearly state his/her expectations of intern

Discussion of intern’s learning goals for the internship

Discussion of how the learning goals would be met

Reading assignments related to the field

Opportunities for training / professional development

List any specific training to be included throughout the internship (safety procedures, software training, seminars, etc.):      

Describe how the supervisor will supervise the intern’s work performance:      

Describe how the supervisor would encourage the intern’s progress toward achieving his/her learning goals for the internship:      

Describe how your agency would handle payroll for the intern:      

Describe how your agency would handle any business-related expenses incurred by the intern (mileage, parking fees, etc.):      

If your agency would choose to pay the intern more than the amount of the grant stipend, please indicate the additional amount (or, if full amount is unknown, then indicate the hourly or weekly rate upon which you would base the additional payment):      

Does your agency plan to hire additional interns this summer? If yes, briefly describe the type of internship(s):      

This completed application must be accompanied by the following documentation

(please check):

A copy of the letter from the Internal Revenue Service stating the agency’s federal tax- exempt 501(c)(3) status. Texas Sales and Use Tax Exemption Certificate is not sufficient.

A copy of your most recent audited financial statement or IRS Form 990.

A copy of your agency’s mission statement and/or agency brochure.

A copy of the intern job description (as detailed as possible).

Do you certify that your nonprofit status has not been revoked and is still in effect?

Does the supervisor (or the Executive Director, in the absence of the supervisor) agree to meet with the Volunteer Houston staff for a site visit during the internship and agree to be available during the summer for any questions or concerns that VH staff may have?

Does your agency agree to the disclaimer and assumption of responsibility set out in the attached guidelines?

If your agency is selected, do you agree:

To send the intern’s supervisor to the Agency Orientation on February 13, 2014?

To send agency staff and/or board representatives to the Program Kickoff in June?

To allow your intern paid-time away from the office to attend two half-day Intern Seminars and a half-day Community Service Project in June and July?

Name of Agency:      

Name of Executive Director:      

Signature of Executive Director: _________________________________ Date: ____________

Thank you for your application. Selected agencies will be notified by January 31.

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