* 1. First Name

* 2. Middle Name

* 3. Last Name

* 4. E-mail Address (You'll receive e-mails from Lilly but can always unsubscribe)

* 5. Phone Number (Just digits, no symbols please) Note: We'll be making calls Jan 12-16 from 5-5:30 PM EST. If you don't answer, we'll have to move to the next person :(

* 6. College (Undergraduate)

* 7. Current Year in School

* 8. Major(s)

* 9. Based on your major and background, what department at Lilly would you MOST like to intern in?

* 10. If you were a Lilly print, what would you look like?

* 11. All-time FAVORITE Lilly Item

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