Youth Engineering and Science Summer Leadership Internship Application 2019

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Email *
A personal Email address that is not your school email address
Your First and Last Name *
The name of the school/college you attend *
Birth date (Month, Day, Year) *
Street Address *
The best phone number by which to reach you *
Another phone number contact in case of emergency. Include the contact person for this phone. *
A second phone number for emergencies. Include the second contact person for this phone.
Your cell phone number *
The name of a reference person. This reference person must be a teacher/professor/mentor or employer who would recommend you for this program that we could contact. (This may not be a family member or friend.) *
Phone number of the reference person. *
Email of this reference person
How do you know this reference person? *
Your Unisex T-shirt size *
Would you be able to work on all of the following dates: July 1,2,3,8,9,10,11,12,15,16,17,18,19,22, 23,24,25,26,29, 30? *
If you chose No, Explain which dates and times you would not be available. If you chose yes, state that you are available for all the times and dates. *
What are the reasons you are applying for this position? *
What contributions could you make or personality traits you have that would be beneficial for working as part of a team to teach educational lessons in science and engineering to children. *
List special skills and qualifications you have from previous employment, volunteer work or through any other activities, including formal education, hobbies, or extra-curricular activities you have participated in. *
Check off all the responsibilities you would be able to carry out well. *
If you did not check a box please explain the reason or reasons. If you checked all the box state that you would be able to carry out all of the responsibilities well. *
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that If I am accepted into the program, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal and in not being accepted in the future. Write your name and today's date. *
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