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* 1. Student’s Name

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* 2. Month and Year of Birth

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* 3. Address

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* 4. Phone Number

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* 5. When are you available to work? (Select all that apply)

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* 6. E-mail Address

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* 7. What is your current status?

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* 8. Areas of interest (select all that apply)

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* 9. What skills are you interested in learning?

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* 10. Describe any student organizations, job experiences, additional coursework, and other skills that you have.

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* 11. Describe your career goals and how this internship will help you reach those goals.

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* 12. How would you like for us to communicate with you?

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