Altec Internship Application Complete the information below to submit your application for the Altech Internship. Name* First Last Birth Date MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home PhoneEmail* Sex Ethnicity Are you currently employed? Yes No If currently working enter name of employer Work PhoneHigh School attended Year Graduated Are you currently enrolled at JSCC? Yes No Hours enrolled this termMajor Previous Colleges AttendedDegree or Certificate Earned List any financial assistance you are now receivingDescribe why you deserve to be awarded this opportunity. Δ