This application is for those students who wish our assistance with locating potential internship sites, which best match your interests, abilities and goals. If you have secured an internship site and wish to earn academic credit, please submit the Registration for Credit form, not this one.

Deadlines for you to submit this application, your resume and your unofficial grade report are:
October 1 for Spring semester
March 1 for Summer term
April 1 for Fall semester

* 1. Last Name

* 2. First Name

* 3. Middle Initial

* 4. ID#

* 5. Permanent Address

* 6. City

* 8. Zip

* 9. Home Phone

* 10. Campus Address

* 11. Campus Phone

* 12. Cell Phone (be sure to include area code)

* 13. Campus Box #

* 14. Email (other than campus mail - e.g., Gmail or Hotmail)

* 18. Academic Advisor (last name, first name)

* 19. GPA (Go to MCSquare and look in DegreeWorks or your unofficial grade report. Copy and paste into Word the page which verifies your GPA. Email that to the Internship Center -

* 20. Position Desired (e.g., Research, Editorial, Counseling, Marketing, etc.)

* 21. Explanation of Position/Experience Desired (what are your interests, type of organization and/or industry, and type of work you wish to do? Rank order your preferences - e.g. "My first choice would be...")

* 23. Term for Participation

* 25. Course You Are Considering (You are not locked into this choice)

* 27. If you are receiving (or eligible for) need-based financial aid, please indicate which sources:

* 28. Do you have your own car?

* 29. Do you intend to hold another job (on or off-campus) during the assignment?

* 30. Do you intend to participate in varsity sports during the internship?

* 31. Are you able to comply with regular attendance expectations as well as meet any other reasonable expectations of the internship site?

* 32. Agreement
I understand that this internship is offered by Messiah College as a curriculum option and is thereby taken for academic credit, requiring my completing academic assignments and paying tuition for credits earned. I authorize the Internship Center to release to potential internship sites information relating to this application and all supporting documents (resume, grade transcript, academic advisor reference) when, in their judgment, it will be relevant to possibly securing a site. If I have a disability or limitation, I agree to cooperate in providing any necessary information that would enable the internship site to provide reasonable accommodation for my participation in an internship experience. I certify that I personally have completed this application and that the information I am providing is complete, accurate and given in good faith.

Before your application packet is complete, you must:
1) Email your resume as a Word attachment to (a sample and guidelines may be found in the "Inquiring Students" section of )
2) DegreeWorks - copy the first page which indicates your cumulative GPA. Paste it into Word, and then email it to

Your academic advisor will be emailed by our office to ask for approval of your application.

When finished, click the "Submit" button.

* 33. ------------ For Internship Center Use Only ------------

Work Study Who Entered Data:

* 34. ------------ For Internship Center Use Only ------------
Data Entered Into Intern Database On (date):