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Please fill out the information for your internship below.

1. YOUR First Name

2. YOUR Last Name

* 3. Your NLU ID Number (begins with an "N")

4. Internship Supervisor's (principal's) FIRST NAME

5. Internship Supervisor's (principal's) LAST NAME

6. Internship Supervisor's (principal's) TITLE

7. Name of School

8. School Grade Level

9. Internship Supervisor's (principal's) EMAIL ADDRESS

10. Internship Supervisor's (principal's) OFFICE MAILING ADDRESS (Street, City, State Zip)

11. How many years has the internship supervisor been in his or her CURRENT position?

12. School Size (student population)

13. Percentage of Free/Reduced Price Lunch Students in School (Poverty Indicator)

14. Percentage of Racial/Ethnic Minority Students in School

15. Percentage of English Language Learner Students in School