Consortium of Indo-Pacific Researchers
INTERNSHIP APPLICATION FORM
Please provide all information below.
Student’s Name: ____________________________________________________________________________
Address: __________________________________________________________________________________
City: ________________State: __________________ Zip Code: _________ Country: ________________
Home Phone Number: _________________________ Cell Phone Number: ___________________________
E-mail Address: ____________________________________________________________________________
School Name: ______________________________________________________________________________
Student’s ID Number: _______________________________________________________________________
List the beginning and end dates you want to do an internship: ______________________________________
List the days and times you are available for work?
_________________________________________________________________________________________
What is your current major/area of study?
__________________________________________________________________________________________
Describe any student organizations, job experiences, additional course work (undergraduate or graduate),
skills, degrees, certifications, or licenses that you have that will help you with this internship.
Student Internship Application Form Page 1 of 2
Describe your career goals and how this internship will help you reach those goals. Be specific about the
experiences you want to gain through this internship and why you believe this internship can provide such an
experience.
What is your current education status (circle one)?
Graduate Student Advance Graduate Student Other
___________________
Student Signature: ______________________________________________ Date: ___________________
Student Internship Application Form Page 2 of 2
