Derby Internship Application

The KESMARC KY Internship can be very physically, mentally, and emotionally demanding. Before making a commitment to KESMARC KY, please ensure that you will be able to honor that commitment.

Application Deadlines:

Spring Block – Recommended submission date October 15th

Summer Block – Recommended submission date January 31st
Fall Block – Recommended submission date April 1st
Winter Block – Recommended submission date July 15th

By submitting this application, you should understand that you will not be permitted to do the following therapies unless explicitly told to do so by a manager: swim, spa. aquatred, hyperbaric chamber

Desired Internship Block: Please note the application deadline dates

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Gender

Date of Birth

YYYY

Medical Status

Are you currently under a doctor's care or have you previously been treated for any medical condition/injury/illness that can impact your ability to perform your duties as an intern or that can place you at increased risk during the performance of those duties? If yes, please describe:

Allergies

Do you have any allergies? If yes, please list:

Do you smoke?

Have you previously applied for an internship with us?

What block did you previously apply for?

Please include season and year

Citizenship

What is your country of citizenship?

Car

Will you be bringing a car?

High School

Do you have a high school diploma? If yes, when did you graduate?

College/University

Please list all post-secondary schools you have attended. Include name of school, location, area of study, years attended, graduation date/projected graduation date, degree obtained.

Work Experience

Please describe your work experience and general information regarding subjects of personal study/research and/or special training/skills.

Equine Experience

Please describe your equine experience particularly experience outside of basic barn skills such as feeding, mucking, etc..

Breeds

Please list breeds you have worked with.

What age did you first start working with horses?

Extracurricular

Please describe any other extracurricular activities or interests.

What are you hoping to gain from an internship with KESMARC KY?

Why should you attend the KESMARC KY Internship?

Correspondence regarding the internship may be conducted via mail, phone, or email. Please add KESMARC KY's email address kesmarcllc@aol.com to your Address Book so that you will receive all correspondence.