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Internship & Independent Study Interest Form 2017-18
INSTRUCTIONS:

1. Take time to review the suggested OPPORTUNITIES http://independentlearning.summitps.org/database (Independent Study options are on this list).
NOTE: These are examples of past internship sites, not a guaranteed spot. You will be searching for an internship just as you would when applying for a job. We encourage you to send us your network of organizations so we can add to this list!
2. Read all sections carefully and respond accurately. ONLY SPS Independent Learning staff will review the answers.
3. Contact IS@summitps.org if you have questions.
4. Have a draft of your RESUME READY. If you do not have it ready you can still submit this form (Or submit a draft)
5. After you have submitted the form, we will contact you with next steps and an internship toolkit so that you can work to find an internship.
6. Check your school email address even when school is not in session. EMAIL WILL BE THE PRIMARY WAY THAT WE COMMUNICATE WITH YOU DURING SCHOOL AND OVER THE SUMMER.
7. Opportunities await. Go for it and let us know how we can help you!

Part 1: Personal Information
Student First Name
Enter your first name exactly as it appears on your passport, school record, drivers licence or other official ID.
Your answer
Student Last Name
Enter your last name exactly as it appears on your passport, school record, driver's licence or other official ID.
Your answer
City
Please tell us the city where you live
Your answer
Student Cell Phone
If you do not have a cell phone, please enter NA
Your answer
Student School Email Address
Your answer
Parent / Legal Guardian Name (first and last)
This should be someone who will be able to access e-mail from us with important requirements / information about the internship program. This person will sign your internship contract.
Your answer
Relationship to student
(e.g. Mother, Father, Grandmother, Aunt)
Your answer
Parent / Guardian E-mail
Your answer
Parent / Guardian Cell Phone
Your answer
Year / Grade for 2017/18 school year
School Mentor Last Name
Your answer
Do you have access to the internet at home or outside of school?
This will allow us to understand how best to support students completing daily timecards
Do you own a smartphone?
We are piloting a new program called Imblaze and are assessing how many students would be able to use the mobile platform.
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