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.*

Option 1

Option 1
Option 2
Option 3
Option 4
Option 5

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

Option 1

Option 1
Option 2
Option 3
Option 4
Option 5

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

Option 1

Option 1
Option 2
Option 3
Option 4
Option 5

Comments about internship opportunity choice.

Will you enroll in an undergraduate degree program during fall 2023?*

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 your letter of Interest*

Upload

Please attach your 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

Letters of Recommendation

You will need to provide two letters of recommendation from individuals familiar with your academic background. Please have letters emailed to the IPS-URE program address: internship@iprefercap.org

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

Letters of Recommendation

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.