Academic Internship Program

Employer Interest Form

Date
Business/Organization Name (Required)
Contact Person
Address 1
Address 2
City
State
Zip Code
Phone Number
Fax Number
Email Address
Website
Internship Title
Number of Interns Needed
Description of Responsibilities

Begin Date	End Date
Number of Hours/Work Schedule:

Salary
Department
On-site Supervisor
Requirements (if any):
GPA	Major
Computer Skills:

Other Skills:

Application Process:
Applicants should mail resume to above address
Applicants should e-mail resume to above address
Other:

If you have any questions, contact Peggy Gilbertson at 314.516.6117.