| School: | Current grade: | ||||||||
| Email: | Parents’ names: | ||||||||
| Home address: | Parents’ emails: | ||||||||
| Why do you want to intern with WIPAC? | |||||||||
| Please write a 100- to 250-word statement below. Things you could include: | |||||||||
| · | Your interest in physics | ||||||||
| · | Personal goals for this internship | ||||||||
| · | Previous experience in physics and programming, including classes (experience is not necessary for acceptance) | ||||||||
| · | Any other information you feel we should know | ||||||||
| The internship runs on Thursdays from 4:30-6:30 pm, Oct. 8 through Dec. 10. Are you available during these times? | |||||||||
| Note: There may be opportunities to continue the internship for spring 2015. | |||||||||
| Yes | |||||||||
| No | |||||||||
| Do you have access to a laptop for the duration of the internship? | |||||||||
| Note: Access to a laptop is not a requirement for internship acceptance. | |||||||||
| Yes | |||||||||
| No | |||||||||
| Please provide a teacher that we may contact as a reference. | |||||||||
| Name: | |||||||||
| Email: | |||||||||
| Phone: | |||||||||