CaT 1 Undergraduate Internship Application
In order to apply for the UCSC Cal Teach Undergraduate Internship you must commit to an internship of 24 hours per quarter in a local middle or high school. Keep this in mind as you are planning your class schedule for the quarter. It is preferable to have two blocks of time of 2-4 hours between 8 am and 3 pm for your school visits.

If you have any questions or concerns please email calteach@ucsc.edu.

Personal Information
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Birth Date *
xx/xx/xxxx
Your answer
Ethnicity *
for UCSC demographic data, answer to the best of your ability with provided categories.
Ethnicity (cont) *
please use this space to further describe your ethnicity if the categories above were inadequate/too broad.
Your answer
Are you a US Citizen or a Foreign Permanent Resident? *
If you are an international student, what is your current visa status?
Gender
(e.g. Female, Male, Other)
Your answer
Additional languages you speak fluently.
Your answer
E-mail
Primary e-mail *
Your answer
Secondary e-mail
Your answer
Address
Local Street Address *
number and street
Your answer
Local: City *
Your answer
Local: State *
Your answer
Local: ZIP *
Your answer
Permanent: Street Address *
number and street
Your answer
Permanent: City *
Your answer
Permanent: State *
Your answer
Permanent: ZIP *
Your answer
Phone Numbers
xxx-xxx-xxxx
Cell *
Your answer
Local
Your answer
Other
Your answer
Emergency Contact
Name *
First Last
Your answer
Phone Number *
(xxx) xxx-xxxx
Your answer
Relationship *
Your answer
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