1. WATKINS MILL HIGH SCHOOL
Student Internship Program
Application Packet
Mrs. Vivian T. Griffin, Intern Coordinator
Vivian_Griffin@mcpsmd.org
2. WATKINS MILL HIGH SCHOOL
Montgomery County Public Schools
10301 Apple Ridge Road
Gaithersburg, Maryland 20879
ACADEMIC INTERNSHIP PROGRAM
APPLICATION FOR 2009-2010
Name________________________________________SS#____________________Grade_____
(Last) (First) (Middle)
Address_______________________________________________________________________
(Street) (Apt. No) (City) (Zip)
_____________________________________________________________________________
_
(Home phone) (e-mail address)
If not a U.S. citizen, do you have a green card? YES NO Date of Birth: ____________
Of what country are you a citizen?____________________
Full Name of Parent or Guardian___________________________________________________
(Last) (First)
Address: ____________________________________________________________________
(Street) (Apt. No) (City) (state) (Zip)
(Work phone) ___________________ (Parent E-mail address) ______________________
Emergency Contact_________________________ Emergency Phone No. ________________
High School: ___________________________________ Current GPA:____________________
Counselor: ________________________ Signature: _________________________________
(please print)
If you are selected to be an intern, you must be able to provide your own transportation to your
internship site. Does this pose a problem? Why?
_____________________________________________________________________________
_
_____________________________________________________________________________
_
Circle your choice: SINGLE PERIOD DOUBLE PERIOD TRIPLE PERIOD
3. (Hospitality Management Completers Must have a minimum of 2.0 credits of internship)
All internships are two semesters unless prior permission is granted. (Most professionals do not want to
train an intern for only one semester.)
Have you had salaried work in the hospitality industry after school or during the summer?
_________________________________
Are your currently employed? YES NO
Employer:______________________________________________Phone #:_________________
Name of Supervisor _______________________________________________________________
Employer Address ________________________________________________________________
Describe your job duties _______________________________________________________________
PreviousEmployer:_____________________________________________Phone #:________________
Name of Supervisor _______________________________________________________________
Employer Address ________________________________________________________________
Describe your job duties _______________________________________________________________
Why did you leave this job? __________________________________________________________
Evaluate your academic performance (circle one): Excellent Good Fair Poor
Current GPA: _______
Comments: _____________________________________________________________________
_____________________________________________________________________________________
Do you have any after-school obligations (for example, family obligations, sports, music lessons) If so,
please list days and hours of the week when these occur
_____________________________________________________________________________________
_____________________________________________________________________________________
Evaluate your school attendance: (circle one) Excellent Good Fair Poor
Number of Days Absent previous semester__________________________________________________
Do you have any health problems that may affect your attendance? _______________________________
What type of career would you like to learn about?____________________________________________
Where would you like to work? _______________________________________________________
