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Brooklyn Technical HS Brooklyn Tech Foundation

Internship Volunteer Services Workshops, Extra Curricula, Summer Program Activities


Tracking Form
Tech Students,
If you participated in any form of internship, volunteering or extra curricula activity during the past school year (Sept. 2015
Aug 2016), please complete the form below and email it back to bths.internship@gmail.com . This form may also provide
useful information for your guidance counselor.

PERSONAL
First Name: ______________________

Last Name: __________________________ OSIS: __________________


None

Gender: M

Grade: __________

Major: ________________________________

BTHS Email: ___________________________________________

Phone: _______________________________

Pref: _________

ACTIVITY

Did you obtain this internship, volunteer opportunity or extra curricula activity from the BTHS website? Yes/ No ______
If yes, please indicate: (Notice No. and Name)
Internship Notice No. ______________________________________________________________________
Volunteer/Community Service Opportunity Notice No. ____________________________________________
Workshops, Enrichment Classes, Summer Programs Notice No. ______________________________________
If No, how did you learn about this opportunity? ________________________________________________________
Was the internship: (Check one)

Paid: _____

Unpaid: _____

Stipend: _____

COMPANY ORGANIZATION
Name of Company/Organization: ___________________________________________________________________
Worksite Address: _______________________________________________________________________________
Worksite Supervisor: _______________________________

Title: _______________________________________

Email: __________________________________________

Phone: ______________________________________

Please describe your experience:

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