Summer Registration Form

SUMMER WORK BASED LEARNING INTERNSHIPS WITH

EASTERSEALS OF THE BIRMINGHAM AREA

(For the Registration Form skip to page 2)
ADVANTAGES TO EMPLOYERS:
- Opportunity to actively get involved in the community and help students in the Birmingham area gain essential work skills with on-the-job experience at no cost to you!
- Give young adults an opportunity to participate in work-based learning experiences and have the opportunity to preview potential employees at no cost to the employer.
- The potential to mentor and teach the next workforce and increase diversity in the workplace!
WHAT ARE WORK-BASED LEARNING INTERNSHIPS?

Work-Based Learning Internships are summer internships that give high school juniors and seniors an opportunity to gain work experience in the real world while learning appropriate workplace ethics and skillsets.
Information Pertaining to Summer Program Participants:
- Participants earn $7.25/hour
- Participants will be paid every other week via a Skylight Card
- Participants will complete 6 weeks worth of employment experience
- Intake Process at ESBA; 529 Beacon Pkwy W, Suite 214, Birmingham, Al 35209
- Intake Dates: June 1st - 4th
- Interviews: 9:00am to 4:00pm
- The deadline to register is May 15
WHAT IS INVOLVED IN THIS PROGRAM?

Our Easterseals consumers will work on a part-time basis and their hours will be based on the need and operating hours of the job site. This is a time-limited internship designed to provide interns with work skills. During this time, students are empowered through employment. During their internship, the following things will be developed:
- Physical Ability & Work Stamina
- Ability to Stay on Task
- Level of Motivation
- Time Management Skills
- Promptness
- Team Work
- Interpersonal Skills
- Promptness
- Team Work
- Interpersonal Skills
- Conflict Resolution Skills
- Personal Strengths, Skills & Individual Passions
Paid Work-Based Internships will begin on June 14th, 2021, and will end on Friday, July 30th with interns placed in businesses for 6-week intervals.
Easterseals changes the way the world defines and views disabilities by making profound, positive differences in people's lives every day.

SUMMER INTERNSHIP REGISTRATION FORM

Easterseals of the Birmingham Area
Student Name
ADRS Counselor
DOB
Gender

Male Female I do not wish to anser
Race
Last Grade Completed
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Alternate Phone

Area Code Phone Number
Emergency Contact Name
Relationship
FOR THE PARENT OR GUARDIAN: Is there is special information we need to know concerning your child?
Easterseals of the Birmingham Area 529 Beacon Parkway West, Ste. 214 . Birmingham, AL 35209. 205.942.6277
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SUMMER INTERNSHIP REGISTRATION FORM