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* 1. Do you give permission for NBTS program staff to access or share your student information for program purposes? 

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* 2. Your full name

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* 3. Do you self-identify as Native American?

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* 4. Where will you be enrolled as an undergrad student is summer 2022?

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* 5. Your email:

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* 6. Please enter your same email again, thanks:

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* 7. Best phone to reach you, if needed:

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* 8. Your address:

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* 9. What is your major?

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* 10. Do you have an internship secured for summer 2022?

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* 11. If you have an internship secured, please describe briefly.

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* 12. Do you need help securing an internship for summer 2022?

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* 13. What type of internship are you interested in? What would you like to learn or gain from an internship?

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* 14. Part of this funding is pairing students with mentors during the internship. Mentors may be professors, supervisors, or other professionals in your field of study willing to help coach and provide helpful guidance to you as you pursue your goals.  We will match you with a mentor and you can decline at any time. 

Are you willing to meet with a mentor periodically during your summer internship?

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* 15. Do you have any other questions for the program manager? 

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