Student Information Name: Email: Phone: Major: Minor 1: Minor 2: Career Interest: # of Credit Hours Completed to Date Faculty Instructor Information Name: Department: Phone: Email: Internship Organization Information Name of Organization: Address: City: StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Phone: Email: Industry: Specific Department Internship Title Site Supervisor: Supervisor Title Internship Information Semester:Please select... Spring Fall Summer 1 Summer 2 Summer 1 & 2 Year: Credit Hours Requested: Internship Course #: Hours of Work per Week: Start Date: End Date: Paid/Rate Or Unpaid: Work Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday Employed by this Organization? Yes No Stipend? Yes No Housing? Yes No How did you find this opportunity? Please forward copies to: Academic Dean Career Office Faculty Advisor Marketing & Public Relations Faculty Instructor Development Office
