Baltimore County Public Schools s2

Office Use Only:

Application: _____ Resume: _____

Teacher Recs:_____ Report Card: ____

Transcript: _____ Essays: _____

GPA: Rank:

Baltimore County Public Schools

Research Internship Application

Date: _________ Current Homeroom Teacher: _____________________________ Present Grade: _______

Personal Information:

Name: ___________________________________________

Last First M.I. Date of Birth: ____________ Age: _____

Address: ____________________________________ City: ________________ State: _______ Zip: __________ Phone No.: ( )______________________________ E-mail: ____________________________________

Parent(s)/Guardian(s)

Father/Male Guardian: _________________________________ Employer: ________________________________

First Last Daytime Phone: ____________________________

Email:

Mother/Female Guardian: ______________________________ Employer: ________________________________

First Last Daytime Phone: ___________________________

Email:

Do you have reliable transportation to and from the internship site? _______________________________________

Internship Information:

What are your career goals? ______________________________________________________________________

Specific occupation in which you would like to pursue research: _________________________________________

Do you have a prospective internship site? ___________________________________________________________

Company: _________________________________ Mentor: ___________________________________

Position: _____________________________________ Phone #: ___________________________________

Related experiences relevant to the internship: ________________________________________________________

_____________________________________________________________________________________________

Please sign below to signify the student’s request and the parent’s/guardian’s approval to apply for the Internship program.

_____________________________________ _______________________________________________

Student Signature Date Parent/Guardian Signature Date

Have you applied for any other senior option? Circle: Work Study Parallel Enrollment Early Release

List the subjects you will need to graduate besides English 12 and Economics: _____________________________

If you are selected for an Internship, which courses would you drop from your registration?

What are your plans for the summer? _______________________________________________________________

What after-school activities do you plan to participate in next year? _______________________________________

Teachers to whom you have given your Recommendation forms: (1)

(2) (3)

Essays

Respond in essay format to the following (use another sheet if necessary):

1. Explain how a research internship would enhance your career goal.

2. What strengths will you bring to a research internship?