Application for Internship Program

Personal Data

Name

(First)	(Middle)	(Last)

Date of Birth

Address

Home Phone	Cell Phone

E-mail Address

Scholastic Data

Current Grade	GPA

Current Semester Schedule
Subject	Teacher	Room
1st
2nd
3rd
4th

List Career & Technical Education courses you are taking or have taken

State your Career Objective or future plans

Work Experience

Name of Employer

Type of Work

Dates of Employment

Do you have transportation?

Student Signature and Date

Approval of Parent/Guardian and Date