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* SexEthnicityAre you currently employed? Yes No If currently working enter name of employerWork PhoneHigh School attendedYear GraduatedAre you currently enrolled at JSCC? Yes No Hours enrolled this termMajorPrevious Colleges AttendedDegree or Certificate EarnedList any financial assistance you are now receivingDescribe why you deserve to be awarded this opportunity. Δ
