Application: Research60 Internship

Availability

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

Student Info

Student - Name

First

Last

Student - Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

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)

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.)

Click or drag a file to this area to upload.

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

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

How did you find us?

*

Promotions

Discount Code

Payment

Total - Non-Refundable Deposit

Price: $ 2,750.00

A non-refundable deposit of 50% is due upon application submission, with the remaining balance due within 48 hours after the student has successfully a screening interview.

Total - Non-Refundable Deposit

Price: $ 2,475.00

A non-refundable deposit of 50% is due upon application submission, with the remaining balance due within 48 hours after the student has successfully a screening interview.

Total - Non-Refundable Deposit

Price: $ 1.00

A non-refundable deposit of 50% is due upon application submission, with the remaining balance due within 48 hours after the student has successfully a screening interview.

Credit Card

Card

Name on Card