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Required
Student Information
Student Name
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required
Birthday
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required
(mm/dd/yyyy)
GPA
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required
Placement Details
Name of Organization
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required
Organization Address
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required
Organization City
*
required
Organization State
*
required
Organization Zip
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required
Site Supervisor Name
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required
Supervisor Job Title
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required
Supervisor Email
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required
Supervisor Phone
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Please tell us about the organization. If possible, please include the organization's Mission Statement.
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Proposed Internship Responsibilities
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Proposed Internship Schedule
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If your schedule is not finalized, please tell us the approximate hours/days per week.
How did you find out about this internship opportunity? How did you connect with your proposed internship supervisor?
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Describe your experience in this field and/or your related skills.
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required
Are you taking any AP exams this year?*
Yes
No
AP Exam Schedule
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required
Have you discussed this with your site supervisor?*
Yes
No
What are your after-school obligations in May?
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required
Ex: athletics, clubs, part-time job, etc.
What is your plan for transportation to and from the internship site?
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required
Please send a confirmation email to the address below*: