Clone of Clean Energy Internship Application Form

Clean Energy Program Application

Thank you for your interest in this program. Please fill the form below accurately to be considered for selection.
- Name*
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Age
- Birth Date*
  
  MonthDayYear
- Primary Phone Number*
  Format: (000) 000-0000.
- Secondary Phone Number
  Format: (000) 000-0000.
- Email*
  example@example.com
- Home Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- CallsTextsEmails
- Black or African AmericanAsian American or Pacific IslanderIndigenous or Native AmericanCaucasian or Non-Hispanic (White)I prefer not to specify
- Hispanic or LatinxNon-HispanicI prefer not to specify
- ManWomanNon-BinaryGenderqueerI prefer not to specify
- YesNo
- What high school do you attend?*
- JuniorSeniorOther
- What is your GPA?*
- Why are you interested in participating in this program? (250 words)*
- What motivated you to apply for this program and how does it align with your goals? (250 words)*
- What skills do you hope to gain from this program?*
- What do you plan to do after this program?*
- What career fields are you presently interested in?*
- Have you participated in any community service or projects related to environmental justice (e.g. recycling, sustainability projects) or clean energy? Please describe
- YesNoI'm not sure yet
- References
  
  Please provide the names and contact information of 1-2 professional or academic references who can speak to your qualifications for this program. (i.e. teacher, former supervisor, school counselor)
- Reference*
- Reference
- Please upload your photo*
  
  Cancelof
- Photo Waiver Release: I hereby grant the NSBE Boston Professionals and the Inspire STEM Workforce Development Program permission to use photographs in any of the following: - Web-based publications- Print advertisements- Organizational newsletter -Special event programming. I hereby affirm that such release to the releasee does not constitute any form of compensation, including royalties arising from the photographs, to my benefit. I understand and agree that photographs in the possession of the releasee shall become the property of the releasee. The use and publication of the photographs, however, shall conform to my rights as a subject of said photographs. I hereby waive my right to inspect or approve the photographs by which my likeness appears. I hereby hold harmless, release, and forever discharge the releasee from all claims and demands, now and in the future, which I, or any person acting on my behalf, may have in connection with this authorization. Age of Consent: I declare true my age of consent, and if I am under the age of such consenting age, I affirm that I have obtained the required consent from my parents/guardians.
  
  I acceptI do not accept
- YesNo
- YesNoI already haveOther
- Do you have any food allergies or medical conditions that you'd like us to be aware of? Please describe.
- Should be Empty:

Clean Energy Program Application