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 an international student?
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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