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1.
Full Name
First Name
Middle Name
Last Name
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2. E-mail address
Email
Verify Email
None
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3. Current Address
Street
Apt. No.
City
State
Zip Code
Phone
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4. Permanent
Address
Street
Apt. No
City
State
Zip Code
Country
(if applicable) Phone
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5. U.S. Citizen
Status:
U.S. Citizen:
Yes
No
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Date of Birth: (mm/dd/yyyy)
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City of birth
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State of birth
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| If born outside the U.S: |
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Country of birth
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City of birth
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Visa Type
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Expiration Date
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6. High School
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Month and year of Graduation: (mm/yyyy)
Name of High School
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City and State
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7. Select the
option that best describes your current academic status.
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Freshman
Sophomore
Junior
Senior
Graduating Senior
Graduate Student
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Applicant
Demographic Data
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Applicant demographic data is important
in assessing the effectiveness of our efforts to solicit applications
from a diverse population. Your submission of this information will
assist us in this regard. We appreciate your cooperation. If you decline
to provide this information, it will in no way affect consideration
of your application.
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| 8.
Gender |
Male
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Female
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9. Ethnicity
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African American
Asian/Pacific Islander
Caucasian American
Hispanic American
Native American Other
(Note: Native American = American Indian,
Eskimo, and other original peoples of North America)
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10. Special Needs
(e.g. visually impaired)
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11. Primary spoken
language
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12. Other languages
you speak
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Applicant School Information
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Students are strongly encouraged
to obtain credit from their educational institutions for this internship
experience. To make arrangements for credit for "independent
study," contact any of your instructors, your academic advisor,
or your school's career placement center to determine the process.
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If you are selected as an Intern in this
program, will you receive academic credit at your college/university
for participating?
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Yes
No
Do not know
Not applicable
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13. College/University
Currently Attending
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College/University
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Address
City
State
Zip
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Date Started
Major
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Minor (if applicable)
Expected Graduation Date
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Expected degree:
2 Year Associate
BA
BS
MA
MS
PhD
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14. Please provide
the following information about your current academic advisor.
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Name
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E-mail
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Phone
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15. The appointment
term for which you are applying is:
Spring
Summer
Fall
Winter
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16.
a. What is the earliest date you can begin your internship?
b. By when do you need to complete your internship?
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17. List all
other colleges and universities that you have previously attended (enter "NONE" if
appropriate). Include approximate dates of attendance
and indicate any degrees earned:
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College/University
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Dates Attended
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18. Certification
of minimum GPA and minimum age eligibility requirements:
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My cumulative GPA for all completed coursework is
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I will be 18 years of age or older at the time of the
internship.
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19. Academic
Honors or Awards. Enter "NA" if appropriate:
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20. List all
courses you are currently taking. Enter "NA" if appropriate.
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1.
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2.
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3.
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4.
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5.
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6.
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21. In the sections
below, indicate your proficiency in the following areas/instruments.
(1 = No Experience, 5 = Proficient)
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Computer Aided Design Software (CAD)
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Spreadsheets
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Statistical Analysis Software (SAS)
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Word Processing
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22. List any additional computer related skills/experience you
may have:
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23. List any programming languages you know (e.g., C, Pascal,
HTML, Java, etc.):
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24. Discuss any special areas of interest you would like to focus
on or develop during your internship.
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Graduating Senior Information
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In order to be eligible for a CI Internship,
you must be a college or university student. If you are a graduating
senior, and your graduation date is scheduled before your internship
begins, please answer the following question:
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25. Have you applied or are you planning to apply to graduate
school?
Yes
No
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If so, which graduate school and in what academic field?
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Resume Attachment
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Paste your resume here (text only).
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End of Application
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I understand that all information in
the application will be provided to the contractors who are involved
in selecting participants.
I certify that to the best of my knowledge
all information contained in this application is accurate.I
understand that any falsification will render me ineligible for
participation.
If you are selected for an internship, you will
need to provide your current college transcript. An 'unofficial'
copy is acceptable.
If you are selected for an internship, you will
be required to provide your Social Security Number for security
and on-site badging purposes.
(Note: You must certify
that you agree with this before you can be considered for selection.)
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You must authenticate this form by typing the two words show in the image below.
(If you cannot read the words, you may refresh the image by clicking the first orange icon.)
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Yes, I agree
Today's Date:
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Thank you for your interest in CI Intern! If you are
chosen, you will be notified via mail.
Please respond within two
weeks whether you will accept or decline the offer.
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