Thank you for your interest in participating in the KBA Internship Connection Program! If you have any difficulties submitting this form or have any questions, please contact J.W. Wells at intern@ksbankers.com or visit the KBA website.

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* 1. First and Last Name:

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* 2. Bank:

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* 3. Are you willing to pay interns for their work? A minimum of $15 per hour is required to participate in the program.

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* 4. What areas of banking are you looking to employ an intern for?
(Select all that apply)

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* 5. Can your bank provide housing for interns? (Housing is not required to participate in the program.)

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* 6. Are there any special needs or circumstances KBA staff should be aware of when pairing you with a intern?

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* 7. Please list all locations where your bank will employ intern(s).
(KBA staff will pair students with housing near these locations. KBA staff will also list these locations on our website and program guides)

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* 8. Please list who the point of contact will be if KBA staff wants to connect an applicant with your bank. Please provide name, email address, and phone number.

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