Career and Technical Education
Internship Application

Student First Name *

Student Last Name *

High School *

Date of Birth *

Student ID Number *

Street Address *

City *

State *

Zip Code *

Parent(s)/Guardian(s) First Name *

Parent(s)/Guardian(s) Last Name *

Parent(s) Email

Student's E-Mail Address *

Current Grade Level *

Home Phone *

Student's Mobile Phone *

Preferred method(s) of communication *

Which means of transportation will you use most? *

Type of Internship Desired *



Purpose of Internship Interest *

Extracurricular Activities *

CTE Course *

High school courses taken

Career Experiences *

Please select the following work-based learning skills that you have acquired.

Work-Based Learning Opportunities *

Explain Other Work-Based Learning Opportunities

What technology skills do you possess that will enhance this experience?

Sex (Check One):

Race (Check all that apply):