2019 Summer Internship Application
The first step in applying to the Summer Internship Program is filling out this form so that we can get to know a little bit about you and your summer interests.

All students need proof of both citizenship and a valid social security number in order to work.

STUDENT INFORMATION
Which high school do you attend? *
Name *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade you are in right now. *
Language spoken at home. *
Your answer
Are you bilingual or multilingual? Check all that apply. *
Required
I identify my gender as: *
Student e-mail *
Your answer
Student cell phone *
Your answer
Home phone *
Your answer
Address (Your Address, City, State, ZIP Code) *
Your answer
Please check your ethnicity *
Required
Are you working now? If so, where? *
Your answer
Have you ever taken the MCAS? *
Did you pass the reading MCAS? *
Did you pass the math MCAS? *
Best way to reach you to schedule an interview (cell phone, home phone, e-mail) *
Your answer
PARENT/GUARDIAN INFORMATION
Mother's Name *
Your answer
Mother's Cell Phone *
Your answer
Mother's E-mail *
Your answer
Father's Name
Your answer
Father's Cell Phone
Your answer
Father's E-mail
Your answer
Guardian's Name
Your answer
Guardian's Cell Phone
Your answer
Guardian's E-mail
Your answer
Emergency Contact Name and Cell:
Your answer
QUESTIONS
How did you hear about this program? Please specify name if it was a high school staff member. *
Your answer
Please select all that apply and mark your top three areas of interest for a job this summer. Please write in an interest if none of these match. *
Required
3. Please describe any past experience you have had in your fields of interest or any other fields (Experience not required but this is helpful information). *
Your answer
Do you qualify for free/reduced lunch? This question is optional, but there may be more job choices if you qualify for free/reduced lunch. If you answer YES to this question, please fill out the next page of this form. *
If you are aware of any time you will need to take off for family vacations, etc. please indicate the dates here. Please be as exact as possible. *
Your answer
Do you have any other commitments this summer that will limit the number of internship hours you may work, such as another job, or summer school? If so please list, and how many hours per week you will spend at these other activities. *
Your answer
Please check places where you can get to work: *
Required
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This form was created inside of LEAP for Education.