Exitus.Al
Intern Contributor Intake Form
1. Full Legal Identity
Full Legal Name
(First, Middle, Last)
Preferred Name
(if different)
Date of Birth
/
Month
/
Day
Year
Date
Nationality/Citizenship
2. Government-Issued Identification
Type of ID
Please Select
Driver's License
State ID
Passport
ID Number
Issuing State or Country
ID Expiration Date
/
Month
/
Day
Year
Date
Upload: Clear photo of ID (front and back if applicable)
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3. Contact Information
Residential Address
(Street, City, State, Zip)
Personal Email Address
Phone Number
4. Digital Communication Handles
(for onboarding, collaboration, and security verification)
Slack Username
(if available)
Telegram Handle
(optional but encouraged)
Discord Handle
(if relevant)
GitHub Profile URL
(required for tech contributors)
5. Professional Profiles
(used for verification, trust scoring, and team cohesion)
Linkedln Profile URL
*
TwitterX Handle
*
Instagram Handle
(optional)
6. Academic + Background Info
Current University/Institution
Degree Program
Expected Graduation Year
GPA
Optional
Portfolio or Project Links
(e.g., GitHub, personal site, Behance)
7. Emergency Contact
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
Emergency Contact Email
example@example.com
Submit
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