Academy of Engineering "Work Based Learning Registration"
The purpose of Work Based Learning is to help you prepare for success in college and your career. This questionnaire allows you to provide information about exploring careers that interest you. Your answers will help in the development and planning of future opportunities for WBL and internship experiences.
Last Name *
Your answer
First Name *
Your answer
Permanent ID # *
Your answer
School Email
Example: mypusd.org
Your answer
Class of *
Secondary Email
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Residential Address *
Your answer
Parents Name *
Your answer
Engineering Career Interest Survey (Option 1) *
First Choice
Engineering Career Interest Survey (Option 2) *
Second Choice
Engineering Career Interest Survey (Option 3) *
Third Choice
Write in the name of employer for previous internship experiences.
Your answer
Submit
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