AgLaunch Summer Internship Application

Summer Immersion Internship Application
Personal Information
Full Name

First Name Last Name
Preferred Name
Date of Birth

Month Day Year
Date
Gender

Male Female Non-binary Transgender I prefer not to answer
Race/Ethnicity *Select all that apply

American Indian or Alaska Native African American or Black African Asian Latinx or Hispanic Middle Eastern White Hawaii Native or Pacific Islander Other
E-mail
example@example.com
Phone Number
Permanent Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Can you provide proof of eligibility to work in the United States?

Yes No
Why are you interested in working for AgLaunch and/or learning more about the AgTech industry?
Education
Name of College
School Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Major
Year
Clubs or Organizations
High School Name, City, State

Will you require housing during the internship?

Yes No
Please list any dates during the internship which you already know you will be gone.
Is there anything else that you would like to add?

Employment
Place
Date

Month Day Year
Date
Tite
Place
Date

Month Day Year
Date
Title
References
Name

First Name Last Name
Relationship
Name

First Name Last Name
Relationship
Acknowledgement
I have read the internship job descriptions and I fully understand the requirements, pay if any, and employment start and end dates. *

Yes
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Summer Immersion Internship Application