Leadership Initiatives 2021 Summer Internship Interest Form
Student First Name
*
Student Last Name
*
Parent First Name
*
Parent Last Name
*
How Did You Hear About Us?
*
Blue Ribbon Schools Program
DECA
Envision
Fusion Academy
HOSA
Indian Bureau of Education
International Internship Program
Mock Trial
National Honor Society
NCHSE Member
Past Summer Student
Presidential Scholars Program
Recommendation
State Department of Education
Teen Court
Other
Name of Student's School (if homeschooled write 'homeschooled')
*
Primary Contact Email
*
example@example.com
Is this email for an interested student or parent?
*
Interested Student Email
Interested Parent Email
Both
Would you like to add additional email information?
*
Yes, for my child
Yes, for my parent
No
Secondary Contact Email
*
example@example.com
Would you like to add a contact phone number?
*
Yes, for my child
Yes, for my parent
No
Phone Number
*
-
Area Code
Phone Number
Would you like to add an additional contact phone number?
*
Yes, for my child
Yes, for my parent
No
Additional Contact Phone Number
-
Area Code
Phone Number
Graduation Year
*
2021
2022
2023
2024
2025
2026
Program of Interest
*
International Business & Leadership Summit
International Business & Leadership Summit Tier II
Advanced Law & Trial Internship Summit
Advanced Law & Trial Internship Summit Tier II
Advanced Medical & Public Health Summit
Advanced Medical Neuroscience Summit
National Security And Intelligence Summit
Which Type Of Program Are You Interested In?
*
In-Person Programs At Georgetown University
Online Programs
Both
Submit
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