Intern Request Form

Intern Request Form
To be completed by employers who are requesting student interns
Company Information
Company Name *
Contact Person *
Contact Person Title *
Contact E-mail *
Contact Phone Number *

Area Code Phone Number
Company Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mailing Address (if different from physical address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Internship Information
Intern Job Title *
Number of Positions Available *
Desired Semester for Internship
Hours per Week
Days per Week
Rate of Pay (May be $0)
Program of Study Requirement

Accounting Building Construction Technology Business Administration Collision Repair & Refinishing Computer Information Technology Computer Integrated Machining Entrepreneurship Healthcare Business Informatics Industrial Systems Technology Medical Office Administration Networking Technology Welding Technology
Minimum Skills Required
Brief Description of Responsibilities
Should be Empty: