Company/Organization: 

Your Name:

Title: 

E-mail: 

Address: 

City: 

State: 

Zip: 

Phone: 

Fax: 

Title of Internship: 

Duties and Responsibilities of Intern: 

Department Reporting to (Marketing, PR, Accounting, etc.): 

Supervisor: 

Title: 

Position Requirements (classes taken, skills student needs): 

Number of hours per week (standard is 15-20): 

Is this position paid?
If yes, how much are you willing to pay?

Date you would like the intern to start: 

Anticipated end date (how long do you expect to have the intern with you?): 

How will the supervisor assist the intern (provide guidance)?

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