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* 1. Please enter your full name:

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* 2. Enter your contact information

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* 3. Email address

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* 4. Cellphone number:

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* 5. What is your date of birth

Date

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* 6. What is your gender?

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* 7. How old are you?

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* 8. What school will you be attending in the fall?

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* 9. Please select the highest grade level you have completed:

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* 10. What is your major or area of study/interest?

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* 11. What is the name of your parent or guardian? (In case of an emergency)

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* 12. ONLY enter your parent's/guardian's address IF different from above:

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* 13. Please enter a reliable number for your parent's/guardian's cell phone number:

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* 15. Please enter an emergency contact name ONLY IF different from parent/guardian.

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* 16. Enter the emergency contact's relationship to the applicant:

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* 17. Urban League involvement

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* 18. List any work or community experience.

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* 19. Financial Support (select all that apply to you)

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* 20. Dwelling or Living Arrangements (student)

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* 21. Access to Transportation

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* 22. Annual household Income (check one)

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* 23. Does applicant have medical or cognitive/conditions that may require accommodation (check all that apply)

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* 24. Do you have appropriate work attire for summer employment?

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* 25. Student Shirt Size (check one)

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* 26. Upload resume here.

Submission of the College Internship Application does NOT guarantee placement for summer employment.

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* 27. If you are selected to participate in a Columbia Urban League Program, are you willing to provide tutoring or mentorship to future program participants?

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