AgLaunch Summer Internship Application

Summer Immersion Internship Application
Personal Information
Full Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemaleNon-binaryTransgenderI prefer not to answer
Race/Ethnicity *Select all that apply

American Indian or Alaska NativeAfrican American or BlackAfricanAsianLatinx or HispanicMiddle EasternWhiteHawaii Native or Pacific IslanderOther
E-mail
example@example.com
Phone Number
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Can you provide proof of eligibility to work in the United States?

YesNo
Why are you interested in working for AgLaunch and/or learning more about the AgTech industry?
Education
Name of College
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Major
Year
Clubs or Organizations
High School Name, City, State

Will you require housing during the internship?

YesNo
Please list any dates during the internship which you already know you will be gone.
Is there anything else that you would like to add?

Employment
Place
Date

MonthDayYear
Date
Tite
Place
Date

MonthDayYear
Date
Title
References
Name

First NameLast Name
Relationship
Name

First NameLast Name
Relationship
Acknowledgement
I have read the internship job descriptions and I fully understand the requirements, pay if any, and employment start and end dates.*

Yes
Should be Empty:

Summer Immersion Internship Application