Application for Student Internship Stipend Program

Thank you for your interest in the Student Internship Stipend Program. The application period for Summer 2019 Interns is now closed. All applicants will receive notification of whether or not they were selected for a stipend award the week of May 03, 2019.

Please feel free to review our FAQ page for more information regarding the Student Internship Stipend Program at http://lodresourcegroup.com/studentinternshipstipendprogram/faq/ or contact us at info@studentinternshipstipendprogram.com

Best wishes and good luck to all interns on your internship!

LOD Resource Group

Student Internship Stipend Program Evaluation Committee

Application Deadline:  APRIL 15, 2019

Evaluation Criteria for Stipend Award will focus on:

• Academic records (Minimum GPA 3.2)
• Demonstration of financial need
• Review of Adversity Statement

Please complete the following application to the best of your knowledge.

First Name*

MI

Last Name*

Primary Telephone*

Alternate Telephone

Email*

Current Address (While on Internship)

Street*

State*

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana mp Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

City*

Select City

Zip*

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Permanent Address

Street*

State*

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana mp Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

City*

Select City

Zip*

Gender*

Male Female Prefer not to say

Disability*

Blind Deaf Physical Handicap Other:Please describe None

Ethnicity*

White Hispanic/Latino Asian American Indian African-American Other Prefer not to say

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Emergency Contact Information

Name*

Phone*

Email*

Relationship to Intern*

Address*

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Financial Information

Are you claimed as a dependent on anyone's Federal income tax return?

Yes No

Relationship to Applicant

Do you have any dependents under the age of 18?

Yes No

Number of dependents*

Relationship to applicant*

Are you currently receiving public assistance?

Welfare Grants Other:Please describe No

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Acknowledgement and Submittal

I understand by submitting this application, I am applying for financial assistance based on a hardship and adversities. I understand that an award of a stipend is not guaranteed and stipends are limited. I also understand that any financial assistance awarded is taxable and further information may be requested from me prior to disbursement of funds.

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Document Uploaded

Internship Offer Letter

College Transcripts

Student Aid Report

Adversity Statement

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