Employer Contacts for Internship, Externship, and Job Shadowing Program

Employer Contacts for Internship, Externship, and Job Shadowing Program

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1. Default Section

1. Personal Information

Personal Information Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

2. Professional information:

Professional information: Specialty:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

3. How do you prefer to be contacted?

How do you prefer to be contacted? Home Email

Home Phone

Office Phone

Office Email

When is the best time for a student to contact you?

4. Please indicate in which areas you are interested in working with students:

	Offer year round	Have students contact me directly	Would like Career Development to organize student contact	Number of students each semester
Job Shadowing (1-2 days observation)	Please indicate in which areas you are interested in working with students: Job Shadowing (1-2 days observation) Offer year round	Have students contact me directly	Would like Career Development to organize student contact	Number of students each semester
Internships (10-12 week experience)	Internships (10-12 week experience) Offer year round	Have students contact me directly	Would like Career Development to organize student contact	Number of students each semester
Externships(week long shadowing experience)	Externships(week long shadowing experience) Offer year round	Have students contact me directly	Would like Career Development to organize student contact	Number of students each semester

Other (please specify)

5. Please indicate below any required skills needed for a position within your company:

Please indicate below any required skills needed for a position within your company:

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