2021 QEM NETWORK TDIS Internship Program Application Form

QEM NETWORK TALENT DEVELOPMENT AND INNOVATION IN SCIENCES INTERNSHIP PROGRAM Application Form

Program Dates: May 24 - July 30, 2021
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
Phone Number *

Area Code Phone Number
College/University *
Does your College or University Identify as one of these types of institutions? *

Historically Black College or University (HBCU) Hispanic Serving Institutions (HSI) Tribal College or University (TCU)
An applicant must be currently enrolled and have successfully completed at least their sophomore year at an accredited, degree-granting institution by the start date of the program.
Classification *
Major *
GPA *
A current resume is required. Your resume should reflect all of your work history including volunteer/service-learning activities as well as research experiences and computer/technology skills.
Upload Resume *
Prepare and attach a 500-word, double-spaced, typed essay addressing the following:
- Career objectives
- How participation in the internship will add to your personal and academic development
- A particular challenge you faced/are facing and how you overcame/are overcoming it
Upload Essay *
A current transcript (an unofficial photocopy is acceptable) is required. Graduate student applicants also must submit a copy of their undergraduate transcripts.
Upload Transcript *
A complete application must include two recommendations (at least one from a departmental faculty member in your major).

List below the names, departmental addresses, email addresses and phone numbers of the individuals from whom you are requesting recommendations for this application.
Name

First Name Last Name
Position/Title
Email
Phone Number

Area Code Phone Number
Recommendations *
Please provide the application link below to the indviduals who will be recommending you for this internship. The form can also be accessed on the Quality Education for Minorities website www.qem.org/qem-internships

Recommendation Form: https://form.jotform.com/QEMNetwork/2021TDISRecommendationForm
Race/Ethnicity (Optional)
Your responses will be used to gather data on how QEM can continue to recruit a diverse internship applicant pool
How did you hear about the TDIS Internship Program?

QEM Website QEM Social Media Faculty/Staff at my College/University National Science Foundation
How did you hear about the internship?
By selecting the submit button, I hereby certify that the information I have provided on this application is accurate to the best of my knowledge. I understand that providing false information could disqualify me from participation in this program.

Incomplete Applications will not be considered.
Should be Empty:

QEM NETWORK TALENT DEVELOPMENT AND INNOVATION IN SCIENCES INTERNSHIP PROGRAM Application Form