Intern Application Form

Name:

First NameLast Name

Birth Date

MonthDayYear

Phone Number:

Area CodePhone Number

E-mail Address:

Address:

Street Address

Street Address Line 2

CityState / Province

How were you referred to us?

High School

High School Graduation Year

What is the last math course your completed? What grade did you receive in that course?

What is your intended major? Answer N/A if undecided.

What math class would you like to take at Whittier? Answer N/A if unknown.

Briefly explain why you would like to participate in this program. (3-5 sentences).

This program requires you to be on campus July 8 to August 7; Monday - Thursday from 10 am to 2:30 pm. Do you have reliable transportation to and from campus for the entire program?

In order to receive the $100 bookstore giftcard, you can only miss up to 2 total class sessions. Are you able to commit to that amount of time?

I understand that this is a commuter program and on-campus housing is not available.

I understand that this is an in-person program and an asynchronous option is not available.

If you answered no to any of the above questions and still want to attend the program, please explain.