First Name: | |
Last Name: | |
email: | |
confirm email: | |
phone: | |
Company Name: | |
Website: | (Format: http://example.com/) |
Address: |
, VA
- ZIP Code +4 ZIP Code +4 Lookup
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Federal Congressional District: |
To find the Congressional District for your organization please visit the House of Representatives Website.
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State Congressional District: |
Virginia State Delegate:
Virginia State Senator:
To find your district number information: General Assembly Website
Please enter your business address in this online form to find your Virginia legislators.
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Secondary Contact Name: | Alternate contact individual at your organization |
Secondary Contact email: | Email address of alternate contact |
Program Agreement: |
View Program Agreement
By entering my name here I acknowledge that I have read and agree to the Program Agreement
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Company Overview: |
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Company Classification: |
Are you considered a small, medium or large company as defined by US Small Business Administration?
- SBA Size Standards Tool - SBA Size Standards
Number of employees:
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Keywords: | Please enter words that describe attributes you are looking for in an intern. In general, the greater the specificity of the term(s) selected, the more effective searches can be (e.g., AutoCAD, C++, robotics, nanotechnology, fluid mechanics, hydrology)
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How did you hear about CSIIP? |
Please Specify:
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Are you interested in working with veterans? Yes No |
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