Internship Application

Empower (500 x 150 px) (5000 x 1500 px) (1).png

APPLICATION

Application for 2024-25

Student Information

Student First Name

High School Name:

Student Last Name

Date of Birth

Graduation Date:

Citizenship/Residency Status

Student Email

Student Phone

Parent Information

Parent First Name

Parent Last Name

Parent Email

Parent Phone

Second/Emergency Phone:

Street Address

Street Address Line 2

City

State

Zip Code

Student Profile

Why?

Plans?

I (student) agree to complete a minimum 85% of classes/assignments, bring a personal laptop to each session, and have reliable transportation.

Yes

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application

Your Signature

Thanks for applying for the EMPOWER Youth Internship! We'll get back to you soon.