<p>Grays Harbor Youth Works Student Intern Application</p><p>Student name: ______Last First M (initial)</p><p>Home Address: ______Street or PO Box </p><p>______City State Zip Code</p><p>School Name: ______</p><p>School Address: ______Street</p><p>______City State Zip Code</p><p>Student Email: ______Student Phone: ______</p><p>Text messages: ______okay ______not okay Please include forms of communication you check regularly. If this is a problem, please talk with the Program Coordinator.</p><p>Parent/Guardian Name(s): ______</p><p>Parent/Guardian Email:______Parent/Guardian Phone: ______</p><p>Birthday (DD/MM/YYY): ______Graduation Year: ______GPA: ______</p><p>- 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.</p><p>After graduation, you are planning to attend: (please check one) ____ College ____ Vocational Training (i.e. automotive, construction, electrical, etc.) ____ Military ____ Not sure: (optional note) ______</p><p>Briefly describe why you want to do an internship:</p><p>______</p><p>______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</p><p>Architecture & Construction Human Services</p><p>Arts, A/V Technology & Communications Information Technology</p><p>Business Management and Admin. Law, Public Safety, Corrections & Security</p><p>Education & Training Manufacturing</p><p>Finance Marketing</p><p>Government & Public Admin. Science, Technology, Engineering, & Mathematics</p><p>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 </p><p>Tuesday </p><p>Wednesday</p><p>Thursday </p><p>Friday </p><p>Saturday </p><p>Sunday </p><p>2. March - April Hours Earnings  30 hours Scholarship 60 hours Scholarship</p><p>3. January – June Hours Earnings  90 hours Half credit, Scholarship 180 hours Full credit, Scholarship</p><p>List any other extracurricular activities that might overlap with the internship period:</p><p>Activity: ______When/how often: ______------</p><p>______Student Signature Date</p><p>______Parent/Guardian Signature Date</p><p>______School Counselor Print Name Signature Date</p>