* indicates required fields

First Name*

Last Name*

Physical Address:

Street

City, State, Zip:

Mailing Address (if different):

 

Street:

City, State, Zip:

Day Telephone:
-

Night Telephone:
-

College Address:

Street

City, State, Zip:

email:*

School attending now:

School attending future:

Major:

Year:
Freshman
Sophmore
Junior
Senior
Graduate

Term:

Goals:

Background:

Scholarship desired?

Residence desired?

Planned start date:

Planned completion date:

All interns will be required to fill out a Waiver of Responsiblity. Please be sure to read this waiver.

If you would like to send a Resumes via an email attachment, please use our contact form and we will send you an email address.

Please have transcripts, three letters of reference (one from Science Dept.), proof of tetanus, insurance and pre-rabies exposure inoculations mailed to:
WSI
P.O. Box 226
Homewood, CA 96145-0226