No student information will be published in the internship directory without the written consent of the student. Student Information Student Name * Email Address * Telephone Number Course Name and Number Major Expected Graduation Date Faculty Internship Coordinator What semester will you complete your internship? (Give the year in the semester that applies.) Would you be willing to be interviewed in regard to the internship to showcase the benefits of your experience? Yes No Internship Directory Contact Information Company Name Street Address City State Zip Code Website Internship Site Coordinator's Name Coordinator's Title Coordinator's Phone Number Coordinator's Email Student Intern's Title Department Project Title Is this a paid internship? Yes No Internship hourly rate: Are the hours flexible? Yes No Additional Comments Math question * 1 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.