Internship Application Form

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

State*

Zip:*

Email*

Phone*

Please Identify the internship opportunity that is your first choice.*

Opportunity 1

Opportunity 1
Opportunity 2
Opportunity 3
Opportunity 4
Opportunity 5
Opportunity 6
Opportunity 7
Opportunity 8
Opportunity 9
Opportunity 10

Please Identify the internship opportunity that is your second choice.*

Opportunity 1

Opportunity 1
Opportunity 2
Opportunity 3
Opportunity 4
Opportunity 5
Opportunity 6
Opportunity 7
Opportunity 8
Opportunity 9
Opportunity 10

Please Identify the internship opportunity that is your third choice.*

Opportunity 1

Opportunity 1
Opportunity 2
Opportunity 3
Opportunity 4
Opportunity 5
Opportunity 6
Opportunity 7
Opportunity 8
Opportunity 9
Opportunity 10

Comments about internship opportunity choice.

Will you enroll in an undergraduate degree program during fall 2022?*

Yes

No

Are you a U.S. Citizen or a Permanent Resident of the U.S.?*

Yes

No

Are you a first generation college student?*

Yes

No

School you currently attend:*

What is your current major?*

Your anticipated date of graduation:*

Have you completed a bachelor's degree?*

Yes

No

Please attach a letter of Introduction*

Upload

Please attach a resume*

Upload

Academic Transcript - Please provide a transcript from your current academic institution.*

Upload

What is your ethnic background? (check all that apply):*

Prefer to self-describe:

Gender*

Female

Male

Non-Binary

Prefer not to identify

Disability status

Two letters of recommendation must be submitted. At least one should be from a professor or course instructor. Students should request that letters be emailed to the IPS-URE program address: internship@iprefercap.org.

For questions about the program, contact internship@iprefercap.org.

Application Package Certification: I certify that all information contained in my Application Package is true and complete. If found to be otherwise, I understand that I will be removed from consideration.