Career Awareness Internship Application

The Career Awareness Internship is a program for Chicago youth (age 14 – 15) who have the motivation, perseverance, and resilience to acquire the necessary education and pursue a career. Acceptance into the Career Awareness Internship is competitive and requires completion of this application and an interview. Applications are due Monday, June 3 at 5PM. Good luck!

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address

Phone Number *

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* 4. Gender

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* 5. Race/Ethnicity

African American/Black

Hispanic

Caucasian

Two or more races

Other (please specify)

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* 6. Birthdate

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* 7. Who do you live with?

Name:

Relationship to you:

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* 8. Last Completed Year in School

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* 9. Which grade school do/did you attend?

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* 10. Which high school do/will you attend?

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* 11. Emergency Contact

Name

Phone Number

Email Address

Relationship to you

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* 12. How did you learn about this program?

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* 13. List 3 words your friends use to describe you

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* 14. What are you passionate about?

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* 15. What are you good at?

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* 16. What are you proud of?

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* 17. On a scale of 1-4 are you:

	1 Never	2 Once in a while	3 Much of the time	4 Always
Adaptable	Adaptable 1 Never	Adaptable 2 Once in a while	Adaptable 3 Much of the time	Adaptable 4 Always
Ambitious	Ambitious 1 Never	Ambitious 2 Once in a while	Ambitious 3 Much of the time	Ambitious 4 Always
Friendly	Friendly 1 Never	Friendly 2 Once in a while	Friendly 3 Much of the time	Friendly 4 Always
Funny	Funny 1 Never	Funny 2 Once in a while	Funny 3 Much of the time	Funny 4 Always
Persistent	Persistent 1 Never	Persistent 2 Once in a while	Persistent 3 Much of the time	Persistent 4 Always
Resilient	Resilient 1 Never	Resilient 2 Once in a while	Resilient 3 Much of the time	Resilient 4 Always
Resourceful	Resourceful 1 Never	Resourceful 2 Once in a while	Resourceful 3 Much of the time	Resourceful 4 Always
Respectful	Respectful 1 Never	Respectful 2 Once in a while	Respectful 3 Much of the time	Respectful 4 Always
Self-Motivated	Self-Motivated 1 Never	Self-Motivated 2 Once in a while	Self-Motivated 3 Much of the time	Self-Motivated 4 Always

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* 18. List one of your personal goals for the summer. What are your plans to reach that goal?

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* 19. Describe a time in your life when you had to persevere. Describe the situation and what you did to keep going.

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* 20. What do you like to do for fun?

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* 21. What motivates you? How do you keep yourself motivated when life isn’t going the way you want it to?

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* 22. List two careers that interest you potentially. Explain why they each interest you.

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* 23. Brag about yourself. Why should we accept you into the Career Awareness Internship?

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* 24. 3 Favorite Subjects in School?

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* 25. 3 Least Favorite Subjects in School?

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* 26. For you school is generally

Easy

Hard

Easy and hard (depending on the class)

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* 27. Do you have an IEP or 504 plan? (We WELCOME students with all types of learning styles! :))

Yes

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* 28. If yes, what is your learning disability?

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* 29. If yes, what kind of accommodations (or help) do you need in the classroom?

If you have any questions, please email Ama Appenteng at amaappenteng@companies-that-care.org or call 312-661-1010