2. 
3. WESTMORELAND COUNTY OFFICE OF THE CORONER
                   Internship Program Application
5. Date of Application*
   Date of Application
6. Semester Requested*
8. Full Name*
10. Age*
11. Date of Birth*
    Date of Birth
12. Sex*

    1. Male
    2. Female
14. Home Address*
16. City*
17. State*
18. Zip*
20. Phone*
21. Email*
23. Any medical or physical conditions that would limit your ability to perform duties of an intern?*

    1. No

    1. Yes
24. Explain Limitations
26. School or University*
28. Advisor Name*
29. Advisor Phone*
31. Address*
33. City*
34. State*
35. Zip*
37. Current Year of Study*
38. Anticipated Graduation*
    Anticipated Graduation
39. Major
    *
41. # Credits Received for Internship*
42. Is this internship a requirement for your major?*

    1. No

    1. Yes
43. Minimum Hours*
    (required by school)
45. Any additional requirements required by school or university?
47. Attach Resume*
    Upload copy of resume.
48. Attach Essay*
    Upload copy of essay.
50. Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my internship application.
52. Signature of Applicant*
55. 
    Westmoreland County Coroner
    2503 South Grande Boulevard
    Greensburg, PA 15601
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field