2011-2012 INT Supervisor Acceptance

1. 2011-2012 Rockefeller Center Internship Supervisor Acceptance

100% of survey complete.

The Dartmouth student who sent you this link is applying for internship funding through the Nelson A. Rockefeller Center for Public Policy and the Social Sciences at Dartmouth. Funding is only available to students who have secured an unpaid internship with clear ties to public policy.

This form is used internally at the Center and is not forwarded to any agencies. This document is simply a work agreement for our mutual understanding. Please note that our funding decisions will not be made without receipt of this form (or similar acceptance notification with a clear contact person listed).

Your input is essential to our selection process. Thank you for your time.

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* 1. Please list -

Supervisor First Name:

Supervisor Last Name:

Organization:

Address:

City/Town:

State:

ZIP:

Country:

Supervisor Email Address:

Phone Number:

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* 2. Who is the applicant that you are completing this form for?

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* 3. Which term (semester) will the internship take place? Exact start and end dates may vary slightly. Please pick the best fit from the list.

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* 4. What TYPE of Organization or Agency are you?

Executive

Government Administration

Judicial

Legislative

Non-Profit

Think Tank

Other (please specify)

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* 5. What is the main POLICY SECTOR of the Organization or Agency that the Dartmouth intern will be working on?

Economic

Education

Environment

Health

International Relations

Law

Other (please specify)

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* 6. At what level of public policy will the Dartmouth intern be working on?

International

Local/Community-Based

National

State

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* 7. Is your organization or agency...

	Yes	No
A Political Campaign?	A Political Campaign? Yes	A Political Campaign? No
Non-Partisan?	Non-Partisan? Yes	Non-Partisan? No
A For-Profit Organization/Business?	A For-Profit Organization/Business? Yes	A For-Profit Organization/Business? No

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* 8. I accept the applicant listed above into my organization as an unpaid volunteer to provide 30-40 hours of meaningful work for him/her during 8-10 weeks of the term noted, and agree to supervise this work to the degree that I can complete a brief evaluation form at the end of the internship period.

Yes

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* 9. Please list the key responsibilities of this internship.

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* 10. The Rockefeller Center has many Curricular and Co-Curricular opportunities for students, regardless of their major or minor. We also offer faculty grants and workshops; have an electronic newsletter; and can post internship/career opportunity listings.

Please indicate which of the following that you would like to know more about and take advantage of Rockefeller Center offerings:

Career Support for students interested in public policy or the public sector

Electronic newsletter (quarterly)

Faculty grants & workshops

Internship Funding

Leadership Programs for Students

Policy Research Shop Testimonies & Policy Briefs

Political Debates & Election Year Events

Public Lectures

Public Policy Classes & the Public Policy Minor

Social Media Outlets (YouTube, Flickr, Facebook)

Special Events

Student Discussion Groups

Washington, DC Dartmouth College Alumni Reception (each year in June)

Not Interested or Other (please specify)