POSITION TITLE__________________________________________________
NO. POSITIONS________________
ORGANIZATION/BUSINESS NAME___________________________________
STREET ADDRESS________________________________________________
CITY, STATE, ZIP_________________________________________________
WEB ADDRESS___________________________________________________
PHONE_______________________
FAX__________________________
AVAILABLE: FALL_____ SPRING_____ SUMMER_____
EMAIL_______________________
HOURS PER WEEK INTERN WILL WORK____
NO. OF WEEKS_____

Would you like this position advertised in our office for future interested students?

YES  - NO

If this is a paid position, what is the pay rate?_______________________________

What tasks will an intern perform in this position?

1.



2.



3.



4.



5.



Who will supervise the intern?

Name______________________________

Title_______________________________

Application Deadline__________________
Application Process_____________________________________________________
____________________________________________________________________

What academic preparation do you feel is necessary for this internship?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Is there any experience an intern should have before doing this internship?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

If this position was created for a specific student, please enter their name below
____________________________________________________________________

Supervisor
Signature____________________________ Date__________________________