Internship Application Form

First Name

Last Name

Date of Birth *

Phone Number *

Current Address *

Permanent Address (if different)

Current Academic Standing (select one) *

Freshman Sophomore Junior Senior PostGrad Grad School Other

Current Major

Major (if applicable)

Internship Goals *

What are your personal interests and goals for this internship? (e.g. working with people, designing curriculum, grant writing, etc.)

Estimated Availability *

Select your preferred internship start date below:

Preferred End Date *

Preferred Ending Date:

Preferred Hours *

How many hours per day will you be available?

How did you find out about ACRES?

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