Grays Harbor Youth Works

Grays Harbor Youth Works Student Intern Application

Student name: ______Last First M (initial)

Home Address: ______Street or PO Box

______City State Zip Code

School Name: ______

School Address: ______Street

______City State Zip Code

Student Email: ______Student Phone: ______

Text messages: ______okay ______not okay Please include forms of communication you check regularly. If this is a problem, please talk with the Program Coordinator.

Parent/Guardian Name(s): ______

Parent/Guardian Email:______Parent/Guardian Phone: ______

Birthday (DD/MM/YYY): ______Graduation Year: ______GPA: ______

- Do you have a car available for use? Yes ____ No ____ - Can your parent drive you to the assigned internship site? Yes ____ No ____ - Will transportation be an issue for you getting to the internship site? Yes ____ No ____ *Funds for county transit passes can be provided.

After graduation, you are planning to attend: (please check one) ____ College ____ Vocational Training (i.e. automotive, construction, electrical, etc.) ____ Military ____ Not sure: (optional note) ______

Briefly describe why you want to do an internship:

______

______Part 1. Please take a Career Cluster Survey in order to determine your “Career Cluster” (the industry you are most interested in) https://www.careerwise.mnscu.edu/careers/clusterSurvey (see all links on GHYW website) Part 2. Which “Career Clusters” or industries are you interested in learning more about prior to graduation? Please select three options and number them 1-3 (1 being your top choice). Agriculture, Food & Natural Resources Hospitality & Tourism

Architecture & Construction Human Services

Arts, A/V Technology & Communications Information Technology

Business Management and Admin. Law, Public Safety, Corrections & Security

Education & Training Manufacturing

Finance Marketing

Government & Public Admin. Science, Technology, Engineering, & Mathematics

Health Science (Medical/Dental) Transportation, Distribution & Logistics Mechanical/Shop Sessions and Hours: (please select only one) Which days will you be available? (mark all that apply) 1. January - March Hours Earnings  30 hours Scholarship 60 hours Scholarship Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

2. March - April Hours Earnings  30 hours Scholarship 60 hours Scholarship

3. January – June Hours Earnings  90 hours Half credit, Scholarship 180 hours Full credit, Scholarship

List any other extracurricular activities that might overlap with the internship period:

Activity: ______When/how often: ______------

______Student Signature Date

______Parent/Guardian Signature Date

______School Counselor Print Name Signature Date