Name

Mailing Address (where you may be reached during application period)

If temporary, add permanent address

Telephone Numbers (where you may be reached during application period). Include permanent telephone number.

E-mail address

Date of Birth

Place of Birth

Citizenship (specify type of visa if not U.S. citizen)

Proposed dates of internship at SITES

If known, please the name(s) of the SITES staff with
whom you wish to intern

Will you be able to work full-time (40 hours per week)?
Will you be able to work part-time (20 hours per week)?

Do you speak and read English fluently? Yes No

How did you learn about the SITES internship program?

Are you covered by health insurance? Yes No

Current academic status (year and major) and institution

Cumulative Grade Point Average

Grade Point Average in Major

Degree expected, institution(s), and anticipated dates of conferral

All degrees held, institution(s), and dates conferred

Institution(s) from which academic transcripts or other academic records are being sent

Work experience (include brief description or send resume to Internship Coordinator Laurie Trippett).

Please list special skills, such as languages, office, computer, or public speaking that you can bring to an internship.

Write an essay (in English) that discusses why you are seeking an internship, especially as related to your academic or professional development and goals. Indicate the types of areas of work in which you wish to participate and/or experience and explain why the SITES staff and facilities are particularly well suited to your needs. They essay should be between 500 and 1,000 words in length.

Please be sure that the information on this form is accurate and current.

Please type your name and today's date as verification that you completed this form.

Remember: You're not quite done yet. Please e-mail or send via mail your letters of recommendation, your resume (if not included in this form), and any other relevant information.