First Name First Name Initial Last Name
Your Home Mailing Address not college address unless they are the same
City
State
Postal Code (Zip)
Phone
Cell Phone
Email
Name of School
Grade Level	College High School
Area (career field) of Interest Electrical Engineering Civil Engineering Mechanical Engineering Other Interest Areas:
Dates Available
Time Availability
I Need to Finish Internship By (Date and Explanation)
I would Prefer and Intership in the Following My Home Town My Home State Any Western States, Please Select Any: AK OR WA ID CA MT NV BC
Attach Your Resume/Cover Letter *Note the resume and cover letter must be in Microsoft WORD format and all in one document.
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