Student Enrollment Form
Please complete this form then click "Sumbit" to register!!!
First Name: Last Name:
Address: City: Zip:
Telephone: Ext: Email:
Fax:
Grade Level (Please check one): 9th 10th 11th 12th Community College
Other
Please indicate you internship preference: Paid Unpaid Both
Please indicate your days & hours of availability:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
0-2 hours/day 2-4 hours/day 4-6 hours/day 6-8 hours/day
Do you have your own transportation? Yes No
Employer:
Position: Work Telephone:
General Description:
Previous Employment Information:
Employer: Position: