REAL Services

In the News:

AARP Applauds Senate Passage of Historic Health Reform Package
Will help Medicare patients by closing the "doughnut hole" and strengthening laws against fraud, waste, and abuse.

Health Care Reform

BBB Alerts Consumers about U.S. Census Workers: Be Cooperative, But Cautious!

Internship Application

Please print the Internship Application and mail it to:

REAL Services
Attn: Tricia Gorden
P.O. Box 1835
South Bend, IN 46634

Name
Street
City/State/Zip
Phone (best way/time to contact)
Email
Date of Birth
Emergency Contact (name, phone, relationship)

Academic Information

College or University Attending
Major
Curent Status (under grad, grad, year, etc)
Expected Date/Semester of Graduation
Semester Applying for
Type of Internship Applying for
Time Needed, If Applicable (#Hours, Semesters(s))
Expected Internship Completion Date (Date/Semester, Month)

Areas of Interest

Nursing Home Patient Advocate (Ombudsman)	Clerical (Data Entry)
Client Care Advocate (Guardianship)	Case Management
LINK-AGE/Aging & Disability Resource Center
Not Sure Or Other:
Other opportunites could be developed to meet Interns educational needs

Please note any Special Skills you have

Counties: Elkhart Kosciusko LaPorte Marshall St. Joseph

Please list any languages, other than English, that you can speak or understand (including sign language):

Time Availability

I am Flexible or:
Preference of Days
Hours available (Morning, Afternoon, Evening)

Is your transportation reliable? If no, explain how you will have reliable transporation available: (You will not be expected to transport clients, but will need to be at necessary appointments.)

Have you ever been convicted of a crime?

References

Please list three (3) references other than relatives or previous employers:

Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted
Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted
Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted

I acknowledge and agree that all information provided herein is accurate and true and hereby authorize REAL Services, Inc. to verify such information, contact references and conduct a criminal background check. I understand that I will not be paid for my services, as this is strictly volunteer work. I have read and understand the above statements.

Agree Disagree Date

REAL Services 1151 S. Michigan Street South Bend, IN 46601 Fax: 574-284-2691 Office Locations List of Holidays our Offices are closed	The Promise of Community Action Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community, and we are dedicated to helping people help themselves and each other. REAL Services, believing in the dignity of all people, will provide services to eligible persons without regard to race, creed, sex, or national origin.
Web site last updated on April 4, 2011	To Report elder abuse: Adult Protective Services