CCCSI Internship Intake Survey
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1. Default Section
1 / 6
1
. Date:
Semester
Year
Current Semester/Year
Fall
Spring
Summer
Date: Current Semester/Year Semester
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Year
*
2
. Student Demographic Information:
Student Demographic Information:
Name:
Student ID #:
Preferred Email Address:
Preferred Phone Number:
3
. I am a
I am a
Male
Female
Other (please specify)
*
4
. My primary ethnic identity is:
My primary ethnic identity is:
African American
Asian Pacific Islander
Caucasian/Non-Hispanic
Latino/Hispanic
Asian
Native American
Multi-Racial
Other (please specify)
*
5
. I am a
I am a
Freshman
Sophomore
Junior
Senior
Other (please specify)
*
6
. I am a student at
I am a student at
Pitzer
Scripps
Claremont-McKenna
Pomona
Harvey-Mudd
Claremont Graduate University
*
7
. This is for
This is for
Class-based Internship
Volunteer
Work-Study
Pitzer Social Responsibility Requirement
Other (please specify)
8
. Are you involved with any other community service activities?
Are you involved with any other community service activities?
Yes
No
9
. If you answered "yes" to Question 8, with which other community service organizations are you involved?
If you answered "yes" to Question 8, with which other community service organizations are you involved?
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