Industry Partnership Internship Program Application

Industry Partnership Internship Program

1. Pennsylvania Employers in the counties of Cameron, Clearfield, Elk, Jefferson, McKean and Potter that hire interns who are currently in or have recently completed a field of study including high school, career and technical education, industry recognized training programs, or an associate degree or higher, that align with the internship position in the Manufacturing Industry may be eligible for 50% reimbursement (up to a $3,000 maximum per intern) of wages paid to these interns during the time period of July 1, 2025 - June 30, 2026.

2. Employers must complete and submit the following application. If you have questions regarding the program's process and requirements, please contact our office at 814-245-1835 or email Fred Redden (fredden@ncwdb.org) or Amber Biondi (abiondi@ncwdb.org).

3. If your application is approved, a memorandum of agreement (MOA) between the company and Workforce Solutions will be developed and sent to the employer contact on this form. Employers will be required to submit additional information which will be outlined in the MOA to include, but not limited to, copies of pay stubs, Employer W-9 form, Employer Feedback Form, and intern/s Entrance Survey, Release of Information, and Essay.

Section 1: Employer Contact and Internship Information
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Industry
Phone Number
Format: (000) 000-0000.
Contact Name

First NameLast Name
Title
Email
example@example.com
Intern Name

First NameLast Name
Intern Start

MonthDayYear
Date
Wage Provided by Employer
NOTE: MUST PAY A MINIMUM OF $14.00/HR
Do you intend to hire the intern full-time upon completion of internship?
Length of Internship
Please describe the work schedule for the intern, i.e. hours per week, month, etc. For example, will the intern work full-time or part-time, how many hours per week, month, etc.

Section 2: Occupational Information and Training Plan
Occupation Job Title
Intern's Role (Job Description)
Describe the relevance of the internship to the intern's program of studies. Please include the current or recently completed program the intern is/was enrolled in.
NOTE: PROGRAM OF STUDY MUST ALIGN WITH INDUSTRY OCCUPATION BEING PREFORMED BY THE INTERN.
Describe the learning objectives for the intern
Describe the methods of training the intern will receive and regular reviews
Describe the core competencies that the intern should possess by the completion of the internship

Section 3: Goal Alignment
Explain how the proposed internship will meet the goals of the Industry Partnership Internship Program as described in the program overview. Our goals are to engage the intern by encouraging them to stay or return to the North Central PA region and to provide the intern with a valuable internship and possible employment with your company. This section is critical in determining the value of the internship. Please be as descriptive as possible. This narrative has a 200 word limit and must address the goals of the Internship Program.

0/200

Section 4: Signatures
Authorized Signature (please type):

First NameLast Name
Title
Today's Date:

MonthDayYear
Date
By signing below, you agree to the terms identified on the Application Criteria:
Equal Opportunity Employment Program
Auxiliary Aids and Services are available to individuals with disabilities
Funding provided by: https://www.workforcesolutionspa.com/categories/resources/pages/stevens-amendment
Should be Empty:

Section 1: Employer Contact and Internship Information