Intermediary
Business Interest

Intermediary Network Business Interest Form

Intermediary Network Business Interest Form
Address
Contact Name #1
Contact Name #2
Middle School Partnership Opportunities (6th - 8th grades)
Please select at least one that interests you.
High School Partnership Opportunities (9th - 12th grades)
Please select at least one that interests you.
Check boxes, or complete information, detailing what your business is willing to host:
If you have marked yes to offer a student internship please provide more details here. (Hours per week, paid or unpaid, etc.)
Careers Represented/Promoted
Please select at least one career area.
MM slash DD slash YYYY
Please list any restrictions that your company may have (age limits, dress code, etc.)
I would like to schedule a meeting with an Iowa Valley Intermediary representative to learn more about the program.
I'm not interested in working with Iowa Valley Intermediary program.
This field is for validation purposes and should be left unchanged.