Internship Interest Form
Share your contact details, background, and internship preferences to be considered for placement.
Applicant Information
Applicant Name
First Name
Last Name
Non-School Email
example@example.com
Parent/Guardian Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Please Select
Male
Female
Non-binary
Prefer not to say
Other
Demographics and School Details
Race or Ethnicity
American Indian or Alaska Native
Asian/Pacific Islander
Black or African American
Hispanic or Latino/Latina
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Prefer to self-describe
County
Please Select
Please Select
Other
School Name
Current Grade
Please Select
Please Select
6th
7th
8th
9th
10th
11th
12th
College Freshman
College Sophomore
College Junior
College Senior
Other
Expected Graduation Year
Internship Preferences
Preferred Internship Period
*
Please Select
Please Select
Fall
Spring
Summer
Year-round
Other
Work Hours Availability
*
Please Select
Please Select
Morning
Afternoon
Evening
Weekends
Flexible
Other
Career Field Interest
*
Please Select
Please Select
Information Technology
Engineering
Healthcare
Education
Business
Arts & Media
Skilled Trades
Finance
Marketing
Other
Interested in High School Tech Internship?
*
Yes
No
Interested in Mental/Behavioral Health-Focused Internship?
*
Yes
No
Completed a Job Shadow or Internship Before?
*
Yes
No
Specific Business You Would Like to Intern With
Has the business been reached out to and placement secured?
*
Yes
No
Not yet
Is this internship for School Credit?
*
Yes
No
School Placement Contact Name
First Name
Middle Name
Last Name
Submit
Should be Empty: