Internship Application

Full Name*

UJ Email address

Cell Phone #

Major(s)*

Minor(s)

Academic Advisor*

Internship Site Name*

Address of Internship site*

Student Intern Title during Internship*

Is this a paid position?*

Yes
No

Intern Supervisor鈥檚 Name*

Intern Supervisor鈥檚 Title

Intern Supervisor鈥檚 Email*

Brief description of intern duties*

How does this internship relate to your major?

How will this internship benefit your career?

Anticipated Start Date*

Anticipated Finish Date*

Are you registered for these credits?*

Yes
No

Please read and select one of the following choices:*

I give the Career Center permission to share my student information, which might include, but is not limited to, name, major of study, and course name/number with my supervisor/employer for this coursecourse (and JSDC-Jamestown/Stutsman Development Corporation if applicable including the Internship Application for JSDC employer payroll reimbursement). In addition, I give the Career Center permission to provide feedback to my supervisor/employer in order to make these learning experiences beneficial.
I do not give permission to share my student information with the employer/supervisor for the experience for this course and will contact the Career Center (Careers@uj.edu) or Undergraduate Dean Jakob Barnard (jakob.barnard@uj.edu) to discuss this further.

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