Apply for Project AHEAD 2021 Preliminary Application

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Project AHEAD 2021 Preliminary Application
ID:1015
Department:Development
Contact Information
* First Name:
Middle Initial:
* Last Name:
* Address:
Optional Line:
* City:
* State (e.g. NY):
* Zip Code:
* Phone (xxx) xxx-xxxx:
* Email:
Project AHEAD information 2021
Personal Information
* High School:
* City, State:
* Date of Graduation:
* GPA/4.0 scale:
* College Attending:
* City, State:
* Date of Graduation:
* GPA/4.0 scale:
* Major, Area of Study:
* Career Plan:
*

*Language Skills. List up to three.

Language
Speak
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Read
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Write
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Language
Speak
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Read
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Write
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Language
Speak
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Read
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency
Write
Basic Proficiency   Working Proficiency   Full Professional Proficiency   Native Bilingual Proficiency

Family Information Parent/Guardian 1
* First Name:
* Last Name:
* Occupation:
* Highest level of education completed:
* Place of Birth:
* Years in U.S.:
*
 

Parent/Guardian 2
* First Name:
* Last Name:
* Occupation:
* Highest level of education completed:
* Place of Birth:
* Years in U.S.:
*
 


Other Information
*Health Career Interest (Rank as many as applicable)
Other:

*Extracurricular Activities and Community Involvement (List up to five, in order of importance to you.)
Dates Hours Per Week
Program/Organizations City, State
Roles and Activities
Dates Hours Per Week
Program/Organizations City, State
Roles and Activities
Dates Hours Per Week
Program/Organizations City, State
Roles and Activities
Dates Hours Per Week
Program/Organizations City, State
Roles and Activities
Dates Hours Per Week
Program/Organizations City, State
Roles and Activities

* How did you hear about Project AHEAD?

* Have you previously applied to Project AHEAD?
Yes   No
If yes, what year?:



Confirmation of Consent
By signing below, I acknowledge that participation in the entirety of the program is expected and required of all Project AHEAD interns. In the event my application is selected, I will accept an internship offer only if I am able to participate in the full nine weeks of the program.

* Signature:
* Date:

Submit
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