Please complete the below fields to submit your application to the Operation Intern Program.

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* 1. Contact Name

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* 2. Title

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* 3. Contact Email

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* 4. Company Name

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* 5. Mailing Address

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* 6. Physical Address

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* 7. City

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* 8. State

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* 9. Zip Code

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* 10. Phone 

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* 11. Type of Business

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* 12. Is your company filed with the IRS as a charity or non-profit?

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* 13. Company Website

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* 14. General brief background information about company:

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* 15. Year company was founded?

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* 16. Total number of employees:

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* 17. How many positions are you applying for funding?

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* 18. Intern/Apprentice Position Title(s):

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* 19. Define in detail 3 learning objectives to be met for each position you are applying for.  Please state the objective and how it will be measured in regards to a desired learned skill or project to be completed:

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* 20. Year the internship/apprenticeship position(s) was created?

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* 21. Internship/Apprenticeship location(s):

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* 22. Proposed Start Date:

Date

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* 23. Proposed End Date:

Date

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* 24. Internship/Apprenticeship Compensation (salary, tuition reimbursement, training, equipment, etc.):

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* 25. Internship or work experience supervisor name:

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* 26. I have read and agree to the Program Guidelines.

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