Internship Registration Form Please complete the form below and submit it to let us know about your internship. Personal InfoStudent ID* Name* First Last Email* Major* Concentration Do you currently have an internship?* Yes No Have you held an internship in the past?* Yes No Internship Title* Are you interested in an internship now or will you be looking for one in the future?* Yes No Current InternshipIs this internship for academic credit?* Yes No Company Name* Company City & State* Supervisor's Name* Supervisor's Email* Supervisor's Phone*Internship Title* Internship Start Date* MM slash DD slash YYYY Internship End Date* MM slash DD slash YYYY Is this internship paid or unpaid?* Paid Unpaid Internship Pay Rate On a scale from 1 to 5, where 1 is completely unsatisfied and 5 is completely satisfied, please rate your internship. 1 2 3 4 5 How did you find your internship?Additional CommentsPast InternshipWas this internship for academic credit?* Yes No Company Name* Company City & State* Supervisor's Name* Supervisor's Email* Supervisor's Phone*Internship Start Date* MM slash DD slash YYYY Internship End Date* MM slash DD slash YYYY Was this internship paid or unpaid?* Paid Unpaid Internship Pay Rate On a scale of 1 to 5, where 1 is completely unsatisfied and 5 is completely satisfied, please rate your internship?* 1 2 3 4 5 How did you find your internship?Have you taken Pre-Internship Seminar Yes No When did you take Pre-Internship Seminar? MM slash DD slash YYYY Would you like to recommend your supervisor for Supervisor of the Year? Yes No Should you be nominated for Intern of the Year? Yes No If yes, a nomination will be sent to your supervisor.Additional CommentsFuture InternshipWhat type of internship are you looking for?What company would your dream internship be with? When would you like to intern?* MM slash DD slash YYYY Have you met with the internship coordinator to discuss internships?* Yes No Would you like to? Yes No Comments and Questions
