Green Hope High School

Internship Request Form

Student Name:_______________________ Date of Request:______________________

Student ID #_______________________ Parking Permit_______________________

Student Completed credits______ Grade level ________Pathway___________________

Requested Date for Internship: Semester: Fall/Spring Year_________________________

Requested Internship Site/Profession ________________________________________

Academic Course Related to Internship_______________________________________

Supervising Teachers______________________________________________________

Student e-mail_______________________ Parent e-mail__________________________

Career Exploration Activities: Shadow/Career Day/Fieldwork/PEPI/ Activities________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Career Plan (interest area)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Related Experience: (paid or unpaid)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature_________________________________ Date_____________________

Parent Signature_______________________________ Date_____________________

CDC Signature________________________________ Date_____________________

Guidance Counselor_____________________________ Date_____________________