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Mayor's Summer Youth Internship Program Worksite Proposal Application

  1. This is the name that will be sent out to the youth on their placement letters so please be accurate.

  2. First Name, Last Name

  3. Example (716) 123-4567

  4. Example (716) 123-4567

  5. Example (

  6. First Name, Last Name

  7. Example (716) 123-4567

  8. This is the address the youth are to report to on the first day of work. Example (65 Niagara Square - Room 1701)

  9. Example (Buffalo)

  10. Example (14202)

  11. Use this box if there are additional specific details you would like the youth to have with their placement letter. Example (We are located on the 17th floor of City Hall)

  12. This is the time that will be on the letter that is sent to the youth to let them know what time they will need to report to your location on the 1st day of work. Please be accurate and let the MSYIP office know immediately if this is to be changed

  13. The Mayor Summer Youth Internship Program does it's best to meet the increasingly growing request for youth at all sites. We are unable to guarantee that we will be able to fill all request but will try our best to assist everyone. Example (20) DO NOT ADD ANY ADDITIONAL DETAILS TO THIS, ONLY PLACE A NUMBER IN THE BOX

  14. Use this box for all other comments your location would like to add with their Worksite Proposal.

  15. By checking this box you hereby certify that all of the information given on this application is correct to the best of your knowledge*

  16. By checking this box you hereby certify that you have permission to register your program for the Mayor's Summer Youth Internship Program.*

  17. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  18. Leave This Blank:

  19. This field is not part of the form submission.