2020 Internship Host Company Registration

Thank you for your time in completing this survey and for your interest in participating in the STEMworks Internship program. If you have applied to host student interns, we will be in contact with you to finalize your application. Please note that student interns are not guaranteed for hosted company projects as the internship spots are dependent on the number of qualified student applications received.

Question Title

* 1. COMPANY/ORGANIZATION INFORMATION

First and Last Name

E-Mail

Company/Organization Name:

Project Site Physical Address:

City:

State:

Zip:

Mailing Address (if different from above):

City, State, Zip:

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* 2. If you are able to provide a donation, make check payable to Maui Economic Development Board. Payment Method:

My check is enclosed

My check will be mailed later by (date):

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* 3. MAIN Assigned Mentor Contact Information if different from Point of Contact

Full Name:

Email:

Office Phone:

Cell Phone:

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* 4. ADDITIONAL Assigned Mentor Contact Information

Full Name:

Email:

Office Phone:

Cell Phone:

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* 5. Please sponsor a student
Each sponsorship is a tax-deductible donation to support the program. MEDBis a 501 (c)(3) non-profit organization.

$4,000 sponsors two students in a work-based learning placement

$2,000 sponsors one student in a work-based learning placement

$1,000

$500

No, not at this time

Other (please specify)

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* 6. Are you able to provide on-site space to complete their intern duties.

Yes

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* 7. Describe the Internship! (Please note this description will be advertised on our website for students applicants)

Project Description:

Internship Job Position

Prerequisite: Student Intern Skillsets Required (e.g., HTML, Basic ArcGIS, Photography DSLR, Video-editing, etc.):

Student Intern Skillsets Requested but NOT Required:

Equipment needed to complete project (e.g., GPS unit, laptop with Photoshop software, etc.):

How many interns is needed for this position?

Question Title

* 8. Do you need another intern?
Please describe a second internship position, if applicable.
(Please note this description will be advertised on our website for students applicants)

Project Description:

Internship Job Position

Prerequisite: Student Intern Skillsets Required (e.g., HTML, Basic ArcGIS, Photography DSLR, Video-editing, etc.):

Student Intern Skillsets Requested but NOT Required:

Equipment needed to complete project (e.g., GPS unit, laptop with Photoshop software, etc.):

How many interns is needed for this position?

Question Title

* 9. Please submit your Memorandum of Agreement with sign signature.
Download Here

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 1. COMPANY/ORGANIZATION INFORMATION

Question Title

* 2. If you are able to provide a donation, make check payable to Maui Economic Development Board. Payment Method:

Question Title

* 3. MAIN Assigned Mentor Contact Information if different from Point of Contact

Question Title

* 4. ADDITIONAL Assigned Mentor Contact Information

Question Title

* 5. Please sponsor a studentEach sponsorship is a tax-deductible donation to support the program. MEDBis a 501 (c)(3) non-profit organization.

Question Title

* 6. Are you able to provide on-site space to complete their intern duties.

Question Title

* 7. Describe the Internship! (Please note this description will be advertised on our website for students applicants)

Question Title

* 8. Do you need another intern?Please describe a second internship position, if applicable.(Please note this description will be advertised on our website for students applicants)

Question Title

* 9. Please submit your Memorandum of Agreement with sign signature.Download Here

* 5. Please sponsor a student
Each sponsorship is a tax-deductible donation to support the program. MEDBis a 501 (c)(3) non-profit organization.

* 8. Do you need another intern?
Please describe a second internship position, if applicable.
(Please note this description will be advertised on our website for students applicants)

* 9. Please submit your Memorandum of Agreement with sign signature.
Download Here