INCENTIVE GRANT PROGRAM (IGP) APPLICATION WISCONSIN DEPARTMENT OF TRANSPORTATION

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DT2272 Incentive Grant Program Application

INCENTIVE GRANT PROGRAM (IGP) APPLICATION

Wisconsin Department of Transportation

DT2272 10/2011

Applicants must complete this application, attach a letter of interest, updated resume, certified copy of transcripts and advisor references in order to be considered for this program.

Name
Address, City, State, ZIP Code
(Area Code) Home Telephone Number	(Area Code)Cell Telephone Number
Email Address	Are you a Wisconsin Resident?		Date Available for Work
	Yes	No

REQUIRED AFFIRMATIVE ACTION PROGRAM INFORMATION

Female	Male
Asian	Black / African American (Not of Hispanic or Latino origin)
Hispanic / Latino	Native American / Pacific Islander
White (Not of Hispanic or Latino origin)

INTERN POSITION FOR WHICH YOU ARE APPLYING
Student must be enrolled in an educational program related to the job title for which you are applying

ACADEMIC INFORMATION

Associate Degree Program

4-year Undergraduate Degree

Name of College or University you are attending

Year Presently in School

Major Program of Study

Number of Academic Credits Attained

Current GPA

What knowledge or skills would you bring to your internship at the Wisconsin Department of Transportation?

What do you hope to gain from your intern experience?

More information may be found at: http://wisconsindot.gov/Pages/about-wisdot/careers/default.aspx

Questions should be directed to the WisDOT AA/EEO Officer at: (608) 266-0208

Send completed application to:

Wisconsin Department of Transportation

AA/EEO Officer, Incentive Grant Program

4802 Sheboygan Ave., Rm. 410

PO Box 7915

Madison, WI 53707-7915

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ADULT EDUCATION INCENTIVE GRANT AWARD SUMMARY OF USES FOR

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