Agency CARE Internship Application

NIGP Internship Program
Name*

First NameLast Name
Agency Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
State*

Street Address

Street Address Line 2

CityState

Zip Code
Summer (May - August)Fall (August – December)Spring (January –April)
8 weeks9 weeks10 weeks11 weeks12 weeks
20 hours per week40 hours per weekOther
VirtualIn PersonHybrid
Supervisor/Mentor Information*
Detailed description of internship, including expected learning outcomes/expectations*
Pay*
Should be Empty:

NIGP Internship Program