Internship Application Form

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

State*

Zip:*

Email*

Phone*

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

A letter of recommendation is required from at least one faculty member at the institution you currently attend (two letters are preferred). 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.