Future Ready Workforce - Business Registration Business Name * Contact Name * Mailing Address Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana 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 DC Zip/Postal Code * Phone Number * Email Address * Are you a Chamber Member? * Yes No Is your student(s) intern a W2 employee? * Yes No Will your student intern work at least 40 hours? * Yes No Tell Us About Your Student Interns Please list all student interns. Submission of this registration does not guarantee approval or reimbursement for any student. 1. Student First and Last Name * Student Demographic - Age * Student Demographic - Gender * Select option... Male Female Decline to Answer Career Field * Paid Hourly Rate * 2. Student First Name and Last Name Student Demographic - Age Student Demographic - Gender Select option... Male Female Decline to Answer Career Field Paid Hourly Rate 3. Student First and Last Name Student Demographic - Age Student Demographic - Gender Select option... Male Female Decline to Answer Career Field Paid Hourly Rate 4. Student First and Last Name Student Demographic - Age Student Demographic - Gender Select option... Male Female Decline to Answer Career Field Paid Hourly Rate 5. Student First and Last Name Student Demographic - Age Student Demographic - Gender Select option... Male Female Decline to Answer Career Field Paid Hourly Rate Questions about this form? Contact Missy at (218) 736-6951 or chamber@fergusfalls.com
