AccessSTEM Team Application

Contact Information

First Name *

Last Name *

Address1 *

Address2

City *

State

Zipcode *

Country

Phone *

Email *

If under 18

If under 18, please complete the following.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Address1

Parent/Guardian Address2

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Zipcode

Parent/Guardian Country

Parent/Guardian Phone

Parent/Guardian Email

Biographical Information

Gender

Date of Birth *

Year

Month

Day

Disability *

Ethnicity

Race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

Veteran of Military Service

Describe any accommodations that you may need in a classroom or work environment.

Academic Background

Currently enrolled in:

High school

Community college

Tech college

Undergraduate program

Graduate program

Name of School/College/University

Graduation Date, or Expected Graduation Date

Subject Area (If Applicable)

Citizenship

Citzenship *

If you are not a U.S. citizen, do you have a right-to-work permit?

If you are an international student, please explain visa/temporary residency in the U.S.

List cities where you are able to work.

Resume

Paste an up-to-date copy of your resume in the box below, or upload it (.doc, .docx, or .pdf).

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Resume Paste

Why are you interested in AccessSTEM?

Write a paragraph or two explaining why you are interested in participating in an AccessSTEM internship and mentoring, and how participation will help you reach your career goals. Include school honors, extracurricular and community activities, work-related experiences, and any other relevant information about yourself.

Paste your response in the box below, or upload it (.doc, .docx, or .pdf).

Essay Upload

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Essay Paste

Recommendation

Provide the name and email address of a teacher, faculty member, or someone who has worked with you closely.

Name of Recommender

Recommender Email Address

Participation Agreement

As a member of AccessSTEM, you must actively communicate with AccessSTEM staff, peers, and mentors. To remain on the AccessSTEM Team and to be eligible for work-related opportunities, such as internships or other paid positions, you must be an “active participant.” As an “active participant,” you are expected to:

Log on to your email account at least once per week and read and respond to email messages.
Notify AccessSTEM staff of any changes in your contact information, or your ability to participate in AccessSTEM internships and activities.

Although we will work with AccessSTEM Team members to plan and initiate disclosure of their disabilities to potential employers, schools, or other organizations in conjunction with AccessSTEM activities, your disability may be disclosed or implied.

DO-IT may request a criminal background check of program participants. Applicants must report any past convictions to DO-IT at the time of application and any further charge or conviction at the time it occurs.

By submitting this form, you agree to these terms. *

I agree

Referral Source

How did you hear about AccessSTEM?

Leave this field blank