Internship Eligibility Form

This eligibility form should be completed by someone who:
Has identified an area of deep interest
Is able to show evidence of commitment to that area of interest
Is aged 14-20 (parent/guardian permission will be required for participants 17 and below, once application is accepted.)

Applicant Information

FIRST Name

LAST Name

EMAIL Address

personal email (not school) is preferred

Confirm EMAIL Address

must match above

Email Error Message

CELL Phone #

XXX-XXX-XXXX

City

State

Initiative ID

Eligibility

What area of interest do you want to explore?

Why are you a good fit for this program?

I am currently enrolled and/or participating in

select all that apply