2019 Internship Program - Bank Commitment Form

Please complete the following information as your commitment to participate in the 2019 VBA Internship Program by March 1, 2019. By completing this form, you are agreeing to the program pricing of $215 per intern. Banks will be invoiced in May 2019, after interns have been hired and banks have submitted final intern numbers to the VBA.

Question Title

* 1. Participant Information:

Bank Name:

President/CEO:

Main Internship Program Contact Name:

Title:

Email:

Phone:

Mailing Address:

Additional Bank Contact:

Title:

Email:

Phone:

Additional Bank Contact:

Title:

Email:

Phone:

Question Title

* 2. We have plans of hosting:

1-3 interns

4-6 interns

7+ interns

Additional Information:

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* 3. Our bank will send the following staff member(s) to the Mentor Orientation on April 10, 2019 from 10:00 a.m. - 2:00 p.m.:

Name/Title:

Email:

Phone:

Dietary Restrictions:

Name/Title:

Email:

Phone:

Dietary Restrictions:

Name/Title:

Email:

Phone:

Dietary Restrictions:

Name/Title:

Email:

Phone:

Dietary Restrictions: