High School Research Internship Application

High School Research Internship Application

You will not be able to save the application form and return to it. Leaving the form before submitting will lose all responses.

Applications Due: April, 11, 2022

Research Internship Duration: June 20- August 5

Application Requirements

FAQ

For questions contact: Sofia Refetoff

refetoff@wisc.edu

Student Information

First & Last Name*

Preferred Name or Nickname

Preferred Pronouns*

Age by June 20, 2022*

Phone Number*

Address; include city & ZIP code*

Email*

High School Name*

Current Grade Level*

Are you in AVID, ESCA, or PEOPLE programs? Select all that apply.*

Select or enter value

Do you participate in the free/reduced lunch program?*

Select or enter value

Do you identify with one or more of the following groups listed in the Minority Health and Health Disparities Research and Education Act of 2000? Please select the group(s).

Select

Do you require public bus transportation passes?*

Select or enter value

School Counselor Name*

School Counselor Email*

School Counselor Phone Number

Parent/Guardian Information

Parent/Guardian First & Last Name*

Parent/ Guardian Phone Number*

Parent/Guardian Email*

Select the highest level of parent/guardian level of education?*

Select or enter value

Do you want to add a second parent/guardian?

Select or enter value

Parent/Guardian 2 First & Last Name

Parent/Guardian 2 Phone Number*

Parent/Guardian 2 Email

Parent/Guardian 2 Level of Education

Select or enter value

Essay & Other Documents

Upload the required application documents. See Application Requirement link at top of application form for essay, resume, reference letter requirements. Check boxes for documents uploaded.

File Upload

Drag and drop files here or

Resume

Essay

Reference Letter

Copy of cumulative high grades (unofficial transcript allowed)

Name of Reference Providing Letter*

Reference 1 Email*

Reference Phone Number

Send me a copy of my responses

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