Mentor a Student Intern Program - Student Application
Student Profile
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Home Phone *
Your answer
Other Phone (Optional)
Your answer
Email Address *
Your answer
Social Insurance Number *
Your answer
Medicare Number *
Your answer
Band Number *
Your answer
Position Requested
If you are not applying for a specific position at this time, you may leave the first 4 answers blank.
Job Title
Your answer
Organization or Business Name
Your answer
Contact Person
Your answer
Contact Person's Phone Number
Your answer
Briefly explain how this employment relates to your field of study or career goal OR if you are not submitting for a specific position, explain what type of work you are looking for.
Your answer
Academic Profile
I am enrolled in: *
School Name *
Your answer
Semester *
Your answer
Program or Major *
Your answer
GPA or Average *
Your answer
Supporting Documentation
Please email the following supporting documents to onawa.jacobs@kedc.biz
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