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Operation Intern Student Eligibility/ Enrollment Form
Please type all of the following information:
* 1. Where will your internship take place? (Please list business/company name):
* 2. First Name:
* 3. Last Name:
* 4. Birth Date:
5. Address 1:
* 6. City:
* 7. State (abr. - drop down)
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
* 8. Zip Code
* 9. Phone:
* 10. Email Address
* 11. Nationality/citizenship:
* 12. Internship job/position title:
* 13. Please provide a description of your career goals and how an internship/work experience opportunity with a North Dakota business or employer will help support your goals.
* 14. I have completed one semester of college.
yes
no
* 15. I will be earning academic credit for this experience.
Yes
No
* 16. School:
17. Degree and Major or High School:
18. Date of High School Graduation:
19. Date of Expected College Graduation
* 20. College Faculty Supervisor (if in college):
* 21. Email Address:
* 22. Internship/work experience area of interest:
* 23. I am a US Citizen or Permanent Legal Immigrant and am attending a North Dakota Institution of Higher Education.
I certify
24. How did you hear about this internship?
* Spam Check
copyright 2009 North Dakota Department of Commerce Division of Workforce Development