Internship Application

Youth Building Bridges, 2019 US-China Leadership Education Initiative Intern Application

I. Intern Applicant Information

* Indicates required field

Name: *

First

Last

Birthday: (mm/dd/yy): *

Student Cell Phone: *

Sex: *

School: *

Student Grade Level: *

Student Email: *

Home Address: *

Line 1

Line 2

City

State

Zip Code

Country

II. Parent Information

Mother's Name: *

First

Last

Mother's Email: *

Mother's Cell Phone Number: *

Father's Name: *

First

Last

Father's Email: *

Father's Cell Phone Number: *

Home Phone: *

III. Medical Insurance

Insurance Company Name: *

Insurance Fax Number: *

Insurance Group Name: *

Insurance Policy Number: *

Insurance Phone Number *

Insurance Company Address *

Line 1

Line 2

City

State

Zip Code

Country

IV. Primary Doctor:

Primary Doctor Name *

Primary Doctor Phone Number: *

V. Dentist:

Dentist Name *

Dentist Phone Number *

VI. Emergency Care Information and Consent to Enroll

I certify that I fully understand the general rules of C&T Youth Technology Academy (CTYTA) and I agree to obey such rules. In case of an emergency, CTYTA has my permission to take my child to the emergency room of the nearest hospital if I cannot be contacted, and the hospital staff has my authorization to provide treatment that a physician deems necessary for the wellbeing of my child. I, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, and discharge CTYTA, its officers, directors, employees, and agents from liability from any and all claims, including but not limited to, physical or mental injury, illness, death, and property loss arising, from participation in activities of CTYTA. I also understand my image may be used in all photos, video and other media under the YBB program. I consent to have my picture taken and used for YBB related content and materials.

VII. Program Participation Option:

Program options *

Programs Part 1 - 3 Programs Part 1 - 4

VIII. Short Answers (Max: 300 Words per prompt):

Tell us about a time when you were placed into a stressful situation, explain how you dealt with the situation. Did you handle it well? If not, what you could have done better? *

What is the most interesting or memorable lesson you had in school? What made it unique? What did you learn from it? *

Tell us about your favorite teacher in school. What qualities made that teacher effective? *

Why are you applying to this position? What qualities do you bring to the position to make you a successful candidate? *

Interviews
All applicants will be asked to participate in an interview. The goal of this interview is to get to know each applicant, and to assure the selection board that the applicant is prepared for the challenges throughout all stages of the internship

Student Signature: *

Date: *

Parent or Guardian Signature: *

Date: *

Submit

Youth Building Bridges, 2019 US-China Leadership Education Initiative Intern Application

II. Parent Information

III. Medical Insurance

IV. Primary Doctor:

V. Dentist:

VI. Emergency Care Information and Consent to Enroll

VII. Program Participation Option:

VIII. Short Answers (Max: 300 Words per prompt):

Home

About

Location

Donate

Contact Us

Youth Building Bridges, 2019 US-China Leadership Education Initiative ​Intern Application

II. Parent Information

III. Medical Insurance

IV. Primary Doctor:

V. Dentist:

VI. Emergency Care Information and Consent to Enroll

VII. Program Participation Option:

VIII. Short Answers (Max: 300 Words per prompt):

Home

About

Location

Donate

Contact Us

Youth Building Bridges, 2019 US-China Leadership Education Initiative Intern Application