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Availability

Date you will be able to begin your internship (month/day/year):*

Student Info

Student – Name*
First Last

Student – Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student – Gmail Address*

InternWorks requires that all students use a personal (not school) Gmail address. Visit gmail.com to create a free account.

Student – American Citizen*

Yes

No

Student – Cell Phone Number*

Student – Date of Birth (MM/DD/YYYY)*
MM slash DD slash YYYY

Student – High School/College*

Student – High School/College Location (City, State/Country)*

Student – Current Grade/Year*

Student – Guidance Counselor/College Advisor Name*

Student – Guidance Counselor/College Advisor Email Address*

Student – Photo (Photo must be uploaded as a .jpg file.)
Accepted file types: jpg, png, Max. file size: 256 MB.

What research area interests you?

What is your first research area of interest?*

What is your second research area of interest?*

Other (optional)

Parent Info

Parent/Guardian – Name*
First Last

Parent/Guardian – Relationship To Student*

Parent/Guardian – Primary Phone Number

Parent /Guardian – Alternate Phone Number

Parent/Guardian – Email Address*

Parent/Guardian – Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you find us?

*
Independent Educational Consultant/Advisor

Independent Educational Consultant/Advisor*

*
Recommended by a friend or colleague

School Guidance Counselor/Advisor
Google
College Coach
Instagram
Facebook
LinkedIn
Email
InternWorks newsletter

Other* (describe below)*
Other* (describe below)

*Describe here if you selected "Others"

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Program Fee

Total

Fee: $6,000.00

Deposit

Discount Code

Fee: $3,000.00

A non-refundable deposit of 50% is due upon application submission. By submitting this application, you authorize InternWorks to charge your credit card for the remaining balance 60 days after your initial deposit payment. The final payment will be automatically charged to the credit card provided on the 60th day following the deposit payment.

Payment Information

Card Number*

Card Number

MM/YY*

MM/YY

CVV*

CVV

Name on card

Name on card

Email
This field is for validation purposes and should be left unchanged.

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