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Internship Placement Program Application
BACKGROUND
First Name
*
Middle Name
*
Last Name
*
Professional Email Address
*
School Email Address
*
Phone
*
Address 1
*
Address 2
City
*
State/Province
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavat Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip
*
Gender
*
Female
Male
Prefer Not to Say
How did you find out about ABPA?
*
ABPA Staff
Student Organization
ABPA Ambassador
Professor
Handshake
Family/Friend
University career Services
Career Fair/ Events
Social Media/ Internet
EDUCATION
What is your level of completed education?
*
High School Diploma/GED
Associates Degree
Some College
Bachelor's
Maaster's
PhD
What is your anticipated or actual graduation date (month/year)?
*
Current Cumulative GPA (out of 4.0)
*
What is your major of study?
*
What is your minor of study?
*
What is your race?
*
Arab-Ameican
Asian
Black/African- American
Hispanic/ Latino
Native American
Native Hawaiian/ Pacific-Islander
White Caucasian
South Asian
Biracial
What is your ethnicity?
*
Do you currently or have you ever received federal financial aid?
*
Yes, I currently or have received federal financial aid
No, I do NOT currently or have ever received federal financial aid
I do no wish to answer
CITIZENSHIP STATUS
What is your Citizenship Status?
*
U.S. Citizen
Green Card Holder
Visa
DISABILITY STATUS
Disability Status
*
YES, I have a disability
NO, I do not have a disability.
I do not wish to answer.
VETERAN STATUS
Veteran Status
*
I AM a Veteran
I am NOT a Veteran
I AM a disabled Veteran
I wish not to answer
What university did/are you attending?
*
What term are you looking to be placed in?
*
Winter/Spring 2021 (January to May)
Summer 2021 (May to August)
Please list any special skills you may have (ex. Foreign language, computer skills, communication skills, etc.)
*
STUDENT AMBASSADOR
Are you interested in becoming a Student Ambassador at your university/college?
*
Yes
Maybe, I'd like to learn more
No
VOLUNTEER
Are you interested in volunteering at ABPA?
*
Yes
Maybe, I'd like to learn more
No, not interested
What Position are you interested in?
*
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