Application: Summer Internship, Summer 2017
This application is for continuing UCLA students who are currently enrolled as an undergraduate at UCLA during Spring Quarter 2017.

*You must be a US Citizen or US Permanent Resident to be eligible for this internship, or AB540. International (F-1) students are not eligible.

You may only participate in a summer internship once; if you have already participated in a previous summer (e.g. Summer 2016, Summer 2015, Summer 2014, etc) then you are not eligible for a second summer, and should not be applying for Summer 2017.

You must be planning to enroll as an undergraduate in Fall 2017.

*Note that misrepresenting your information on the application (e.g. your current major, current minor, and/or Cal Teach courses taken) may result in dismissal from the program and rescinding of the scholarship amount in its entirety.

What is your UCLA ID number? *
Use format 123456789; do not use dashes or spaces; should be 9 digits
Your answer
Your name: First *
Your answer
Your name: Middle
Leave blank, if none
Your answer
Your name: Last *
Your answer
Email: *
Your answer
Cell phone number: *
Use format 123-456-7890
Your answer
Date of birth: *
Use format mm/dd/yyyy
Your answer
When did you first enter UCLA? *
When did you first enter UCLA? *
Expected graduation *
Expected graduation *
Major *
Please provide your currently declared major
Your answer
Please provide your currently declare minor; Leave blank if none
Your answer
Did you transfer to UCLA from another college or university? *
If yes, from where did you transfer?
Your answer
Which Cal Teach courses have you taken?
Please check all that apply; leave blank if none. Include courses that you are currently enrolled in for Spring 2017.
Are you more interested in observing a math or science classroom? *
Internship availability:
Orientation is scheduled for Sunday, September 17, from 1:00 - 4:00 p.m. at UCLA. You MUST be available for this orientation.

Internships will take place on Monday (9/18), Tuesday (9/19), Wednesday (9/20), and Friday (9/22). There are no internships on Thursday (9/21) due to a school holiday at many of our partner schools. Students are required to spend at least 24 hours total observing in the partner school. You must attend all 4 days for the entire school day (~6 - 7 hours per day). Exact start and end times at the school will vary by school, and you will need to plan for travel time to and from the school. Therefore you should not make other commitments from roughly 7:00 a.m. to 5:00 p.m. on your internship days. (School assignments will be provided at the orientation).

The Follow-up meeting will be scheduled for two hours on Tuesday (9/26) from 9:00 - 11:00 a.m. at UCLA.

Orientation *
Are you available for the orientation on Sunday, Sept. 17 from 1:00 - 4:00 p.m. on the UCLA campus?
School Internship *
Please confirm your availability for the following 4 days roughly between 7 a.m. and 5 p.m.. (This time window includes travel to and from the school, and is not exact.) Check all that apply. You may make comments, if necessary, in the comments box below.
Follow Up Meeting *
Are you available for the follow up meeting on Tuesday, Sept. 26, from 9:00 - 11:00 a.m. on the UCLA campus?
OPTIONAL COMMENTS regarding availability:
Your answer
If accepted, we will try to place you within a reasonable distance of your starting location, but cannot guarantee a specific school. We will only arrange transportation (in the form of carpooling using a UCLA rental car) for those students commuting to and from UCLA (or very near vicinity). If you are commuting from a non-UCLA location (e.g. your home), you must provide your own transportation (e.g. drive your own car, take the bus, or arrange a carpool on your own). Please note that there is no cost to you associated with driving a UCLA rental car; we cover the rental fee including tank of gas, and liability insurance, and parking is provided for free on the UCLA campus.
Please indicate your commute location for Monday through Friday (school internship days): *
Note that "very near vicinity" to UCLA means that you are willing to carpool with others to/from UCLA.
Please provide your commuting address (including street, city, and zip code):
Your answer
Your answer
Your answer
Do you have a valid driver license? *
License must be unexpired and valid during the internship week. Unexpired out-of-state license is acceptable.
Do you have a car? *
If you have access to a car to travel to and from your internship site, please indicate so below
Would you be willing to drive a rental car between UCLA and your assigned school?
Rental cars will be provided at no cost to you, and are compact cars (up to four passengers), not vans. Parking is provided free on the UCLA campus.
If you are willing to drive a rental car, are you comfortable driving with passengers?
OPTIONAL COMMENTS regarding transportation:
If you don't yet know your commute location or whether you will have access to a car, please explain below. You may also make specific requests to carpool with your friends, although we cannot guarantee that we will be able to honor all such requests.
Your answer
TB Test:
A negative TB test taken within 6 months of starting the internship is required in order to attend classes at your assigned school. The test must be dated March 18, 2017 or later. We must have a copy of your negative TB test in our office no later than September 1, 2017. You should send your copy either via email ( or fax (310-825-4795). You may not attend your internship without a copy of your negative TB on file in our office. You must submit a new test even if you previously participated in a Cal Teach seminar (unless the test on file in our office is dated March 18, 2017 or later).
TB test *
Additional information:
Payment *
You will be paid the $450 as a scholarship during Fall Quarter 2017 through the Financial Aid Office, subject to constraints imposed by financial aid. Please note that this scholarship payment may reduce your loans or other scholarships, depending upon your circumstances. Unfortunately, we cannot make payment through any other process to avoid these financial aid constraints. Also, you must be enrolled as an undergraduate during Fall 2017 in order to pay you.
Please confirm: *
Due to constraints imposed by funding sources, international students (F-1) are not eligible for this internship.
Please confirm:
Please respond to the following question:
Why are you interested in participating in the summer internship? *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms