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Student Intern Application

Intern Name*
First Last
Class Year*
Date of Birth*
MM slash DD slash YYYY
Cell Phone*
Email*
Address
Street Address Address Line 2 City State ZIP Code
Dates available (May - August):*
Internship commitments are for a minimum of 4-6 weeks
Top 5 Fields of Interest:*
What are your objectives in undertaking an internship? How does it fit within your career plan? (250 words or less)
Is there any other information you would like to share with the Student Engagement Committee?
Emergency Contact
Name*
Phone*
Relationship*
Optional References
Reference 1
Name
First Last
Relationship
Email
Phone
Reference 2
Name
First Last
Relationship
Email
Phone
I certify that my answers are true and complete to the best of my knowledge. If this application leads to an internship through the Gulliver Alumni Association's Internship Program, I understand that false or misleading information in my application or interview may result in my release. I agree to allow the Student Engagement Committee to investigate my references, work record and education.