EmailMe Form - JA Company Program Virtual Pilot Internship

Student Name *

First Last

Parent/Guardian Name *

First Last

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Student Email *

Parent Email *

Parent will need to confirm applicant's ability to complete the work required during the internship as specified in the FAQ document on the JAofNNE website.

Student Phone *

### - ### - ####

Parent/Guardian Phone *

### - ### - ####

School Name *

Graduation year *

Gender *

Male

Female

Non-binary

Have you participated in JA programs before? *

Yes

No

How did you hear about the JA Company Program Virtual Internship Opportunity?

Paragraph Text *

What do you hope to learn by becoming a JA Company Program Virtual Intern? What makes you qualified for this position?

Paragraph Text *

In consideration of the opportunity to appear as described below, I, either on my own behalf, or as the parent/guardian/custodian of this applicant (who is under 18 years of age) hereby grant Junior Achievement of Northern New England the right to record all communication conducted on Microsoft Teams during the JACP Virtual Pilot Internship.

I consent and grant Junior Achievement of Northern New England, its officers, directors, employees, licensees, agents, independent contractors, successors or assigns (collectively, “Junior Achievement”) the irrevocable right and permission to reproduce, take, modify, broadcast, use, re-use, publish, display, copyright or distribute my name, photograph, portrait, other likeness, voice, or speech, (“Works”), for marketing, advertising, promotion or other commercial or noncommercial purposes in any medium in perpetuity. Such media include, but are not limited to, video, audio, promotional materials, press releases, publications, still photographs, catalogs, web sites, social media, and all other media, including websites or electronic social media sites belonging to Junior Achievement.

I hereby release and assign over to Junior Achievement any rights to the Works and hereby waive my rights of privacy or compensation which I may have in connection with the use of the Works and release Junior Achievement from any and all claims that may arise, including any claims of invasion of right to privacy, defamation, infringement of moral rights, rights of publicity or copyrights. I hereby waive any right that I may have to inspect or approve the Works or the use to which the Works may be applied. All copies, negatives, prints, digital reproductions, and derivative works of the Works, as applicable, shall be the property of Junior Achievement.

I affirm that I have been given an opportunity to review this consent and confer with legal counsel, and I understand that I may refuse to sign this authorization.

Electronic Signature *

By signing this application, you agree that all information provide is current and accurate and that you agree to the requirements of the program.

Date *

By signing this application, you agree that all information provide is current and accurate and that you agree to the requirements of the program.

If accepted, I agree to commit to the entirety of the JACP Virtual Pilot Internship, will attend all virtual meetings and complete the work as specified in the FAQ document located on the JAofNNE website.

Electronic Signature *

By signing this application, you agree that all information provide is current and accurate and that you agree to the requirements of the program.

Date *

By signing this application, you agree that all information provide is current and accurate and that you agree to the requirements of the program.