Internship Interest Survey (Students)

Internship Interest Survey (Students)

Students under age 18 will need a parent signature to complete this survey.
Student Name*

First NameLast Name
Student Phone Number*
Please enter a valid phone number.
Student Personal Email (non-school email)*
example@example.com
Parent/Guardian Name(s)

First Name(s)Last Name
Parent(s) Phone Number
Please enter a valid phone number.
Parent Email
example@example.com
What area are you in?*

Martinsville CityHenry CountyDanville CityPittsylvania CountyAmeliaBrunswickBuckinghamCharlotteCumberlandHalifaxLunenburgMecklenburgNottowayPatrick CountyPrince EdwardOther
Academic Level*

High School FreshmanHigh School SophomoreHigh School JuniorHigh School SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege Senior
Age*
What is your current GPA?*
What school do you attend?*
*College Students Only* What is your major or field of study?
Please rank the following career clusters based on your level of interest. Select your first choice. *
Select your second choice. *
Select your third choice. *
What type of internship do you prefer? (remote positions not guaranteed)*

In-personVirtual/RemoteHybrid (Combination of in-person and virtual)
How long can you commit to an internship position?*

6 weeks8 weeks10 weeksPart-time (Less than 40 hours per week)Full-time (Typically 40 hours per week)I'm open and flexible
Where do you go to find internships? (Choose all that apply)*

Major ClarityHandshakeSimplicityMy school's websiteSocial MediaOther
What motivates you to seek an internship? (Choose all that apply)*

Career advancement in your chosen industryCompensation/PayExposure to company cultureOpportunity for a full-time positionGaining hands-on experienceBuilding a professional networkExploring potential career pathsFulfilling academic requirementsOther
Do you have any specific companies or organizations in mind where you'd like to intern? If yes, please list the name, type of business, general location, and or a contact you may have at this business. (Ex. I would prefer to work at a vet clinic in Danville City. Mike Rogers is the manager there.)*
What are your primary goals or expectations for your internship experience? (e.g., specific skills to learn, projects to work on, or outcomes to achieve)*
Please share any additional comments or questions you have about internships or the internship process.*
How did you hear about this opportunity?*
By signing this form, you acknowledge your understanding that, as a student, you may be contacted by internship personnel, including but not limited to employers, work-based learning coordinators, staffing agency personnel, and other pertinent individuals connected to internship opportunities.
Student Signature*

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By signing this form, you acknowledge your understanding that, as a parent/guardian, you and/or your child may be contacted by internship personnel, including but not limited to employers, work-based learning coordinators, staffing agency personnel, and other pertinent individuals connected to internship opportunities. NOT REQUIRED FOR STUDENTS OVER THE AGE OF 18.
Parent/Guardian Signature

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