Academic Internship Questionnaire

Academic Internship Questionnaire

This form is the first step to making your internship a success! Please include as much detail as you can. You will be contacted within 7 business days to continue the conversation. If you have any questions please contact david.prieb@coconino.edu.
Name *

First Name Last Name
CCC Email *
example@example.com
Personal Email Address: *
example@example.com
Comet ID: *
Phone Number: *
Declared Major: *
Do you have an Academic Advisor? *
What semester would you like to do your internship? *

Summer 2022 Fall 2022 Spring 2023 I'm not sure
Do you have a company in mind you'd like to intern at? If so, which one? *
What is the preferred location for your placement site (Flagstaff, Williams, Page, etc)? Are there any transportation issues we need to keep in mind? *
Briefly describe what you would like to do or learn during your internship. If your degree can be used in multiple areas please indicate which direction you'd like to pursue. (For example, if you're a CIS student please indicate if you prefer an internship that focuses on networking, graphic design, web design, etc). *
Do you know how many credit hours your internship needs to be? *
Are there any disability related accommodations you'll need to be successful? *

Yes No
Please describe what accommodations you may need. You can also reach out to our Disability Resources Dept: https://www.coconino.edu/disability-resources
Have you spoken to a faculty member or advisor about your internship? If so, who? (We can involve them in future conversations). *
Anything else that would be good for us to know?
Should be Empty: