Employer Internship Application Form
Bitney College Prep Charter High School Internship Program
Date
MM
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DD
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YYYY
Name of Business *
Your answer
Type of Business
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Worksite Location
Where intern will be placed if different from above
Your answer
Internship Contact *
Every host should have a contact person in charge of planning the internship and facilitating the daily responsibilities of the intern. This may be the same as the worksite supervisor.
Your answer
Contact Position
Your answer
Contact Cell Phone #
Your answer
Contact Work Phone # *
Your answer
Contact Fax #
Your answer
Contact Email Address *
Your answer
Preferred Contact Method
Worksite Supervisor
If different from Contact above
Your answer
Supervisor Position
Your answer
Supervisor Cell Phone #
Your answer
Supervisor Work Phone #
Your answer
Supervisor Fax #
Your answer
Supervisor Email Address
Your answer
Preferred Supervisor Contact Method
Internship Information
Title of position
Your answer
Number of positions available
Working Hours
Your answer
Number of hours per week
typically 4-12
Your answer
Requested Start Date
if applicable
MM
/
DD
/
YYYY
Goals for your intern
Please descibe what you would want your intern to learn and get out of his/her experience
Your answer
Placement Information
Please list the skills (i.e. Microsoft Excel) that are necessary for an intern to have a successful experience with your company (this is the first employment experience for many of our participants).
Your answer
Day-to-day tasks
Please list the possible tasks and duties the intern wil perform during her/his internship
Your answer
Special Projects
Special projects can enhance the learning that occurs through everday tasks. Please list your ideas for special projects that your intern can complete. These should go beyond clerical/office work and help the intern build more sophisticated skills (i.e. researching, writing, or presenting) and/or learn about careers in your specific industry.
Your answer
Ongoing Mentoring and Evaluation
Please describe how often and how you will check in with and evaluate your intern.
Your answer
Scheduling Requests
Please provide any additional information regarding scheduling requirements and/or shifts
Your answer
Additional Information
Please provide any additional information about the internship that yo will offer to an intern. Provide any additional relevant information that will help us to match an intern to your worksite.
Your answer
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