Burke County Public Schools Internship/Work-Based Learning Application
Please submit a COMPLETED application, answering all fields requested. Write N/A when not applicable to you.
Last Name
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First Name
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Mailing Address:
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Home Phone #
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Cell Phone #
Your answer
Student ID Number (lunch #)
Your answer
Grade Level (2017-2018)
Birthdate
MM
/
DD
/
YYYY
High School
School Email Address
Your answer
Have you done previous job shadows or internships as a volunteer?
Your answer
Have you ever been convicted of a misdemeanor or felony?*
Explain Conviction
Your answer
Have you ever been suspended from school?*
Explain suspension
Your answer
Will you have a job, sports, or other major commitments during the time you are requesting this program?
What means of transportation will you use to get to a work-based learning site?*
Your answer
Semester Requesting Internship
Select the WBL program you are interested in* *
Required
Explain why you would like to have an Internships and your future plans.
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Career Interest Options
Specific Company Internships Request
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Specific Requests:
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If you already have a sponsor for your internship, please write in the business name, contact person and phone #. (Approval pending)
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