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EmpowerHer: Summer Paid Internship Program







Date of Birth:

School Name:

Current Grade Level:

Lead- Borough:

Do you have working papers?:

Are you eligible to work in the US?:

Do you have a Social Security Number?:

Parent/Guardian Full Name:

Parent/Guardian Phone Number:

Parent/Guardian Email:

Why are you interested in this summer program:

What career fields are you interested in?

Have you participated in any other job training program? 

Which program/workforce training?:

Can you commit to the full 7-week program?:

Are you able to commute to the sites?:

Allergy/Med conditions we should know?: