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?

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