*First Name :
*Last Name :
*Preferred Email Address :
*Preferred Phone :
*Please indicate your status :
Friend of college
Alumni Class Year/Child's Class Year :
If alumni, please indicate your undergraduate major(s) :
Externship Location Information :
*Sponsor's Title :
*Sponsor's Department :
*Business Address 1 :
Business Address 2 :
DISTRICT OF COLUMBIA
FEDERATED STATES OF MICRONESIA
NORTHERN MARIANA ISLANDS
*Zip Code :
Web Address :
*Work Phone :
*Work Email :
Briefly describe your organization and job responsibilities :
*List what the Extern will learn/observe
How many days will the Externship be ? (Externships are 3-5 consecutive days) and which days during Extern weeks (January 4-16 2016)?
January 4January 5January 6January 7January 8January 11January 12January 13January 14January 15
*How many Externs are you willing to Host?12
*Have you received approval (if required) from your supervisor/administrators to be an Extern Sponsor?
*If No, please indicate when and how you will be obtaining this approval.
*Does your organization require paperwork/forms/agreements/clearances to be completed by the College or Student Extern prior to participating in the program?
*If Yes, please describe below in as much detail as possible.
* Required Fields