(2024) Fort Wayne Intern Experience Interest Form

Fort Wayne Intern Experience by Greater Fort Wayne Inc.

Interest Form
Name*

First NameLast Name
Personal Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birth Date*

MonthDayYear
Date
As part of Greater Fort Wayne Inc.'s commitment to diversity, equity, and inclusion, please share how you identify. This data is confidential and will only be shared with GFW Inc. program personnel for grants and reporting.

White or CaucasianBlack or African AmericanHispanic or LatinxAsian or Asian AmericanAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslandersPrefer not to answerOther
Are you active personnel of any branch of military?
Hometown (Where do you call home?)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
College*
Graduation Year (Expected)*
Declared Major
Internship Company*
Internship Email*
On a Scale of 1-5, please rate your level of agreement.

1 meaning 'totally disagree' & 5 meaning 'totally agree'
Fort Wayne is an exciting place. *

1

2

3

4

5

1 is Disagree, 5 is Agree
I could see myself living in Fort Wayne after graduation.*

1

2

3

4

5

1 is Disagree, 5 is Agree
I could see myself getting a job in Fort Wayne after graduation.*

1

2

3

4

5

1 is Disagree, 5 is Agree
How did you hear about this program?
What are your expectations of the program?
Would you refer a friend to join an event with you? If so, share their name and contact information:
First and Last Name
Would you refer a friend to join an event with you? If so, share their contact information:
Email address
Image and Media Release Statement
By participating in this event or program, I give my permission to Greater Fort Wayne Inc., along with its partners and those authorized by the organization, to capture and utilize photographs, videos, and audio recordings featuring me from the course of the event or program. These materials may be used in various media formats now known or developed in the future for purposes including, but not limited to, promotional activities, marketing efforts, public relations initiatives, and grant reporting, all without the need for further consent or any form of compensation on my part. I acknowledge that such photographs, videos, and audio recordings will be owned by Greater Fort Wayne Inc., and I waive any rights to review or approve their usage. Additionally, I release Greater Fort Wayne Inc., along with its leadership, employees, partners, and representatives, from any potential claims or liabilities related to the usage of my image, voice, or likeness.

I acknowledge that such photographs, videos, and audio recordings will be owned by Greater Fort Wayne Inc., and I waive any rights to review or approve their usage. Additionally, I release Greater Fort Wayne Inc., along with its leadership, employees, partners, and representatives, from any potential claims or liabilities related to the usage of my image, voice, or likeness. This consent covers all photographic, audio, and video recordings gathered during the events or programs led by Greater Fort Wayne Inc., in which I may take part.
Should be Empty:

Fort Wayne Intern Experience by Greater Fort Wayne Inc.

On a Scale of 1-5, please rate your level of agreement.

Image and Media Release Statement