Student Internship Program Employer Registration
Thank you for helping to create a unique learning opportunity for a local student! In order to best match your company with an intern, please complete the following information to be shared with students as part of the selection process. Please complete a separate form for each different internship position you are offering.
Intern Host/Mentor Name *
Your answer
Intern Host/Mentor Email *
Your answer
Company Name (No abbreviations please) *
Your answer
Address, City, State, ZIP Code
Your answer
Phone Number
Your answer
Industry Type (e.g., Energy, Social Services, etc.)
Your answer
If you can take multiple interns for one position, please note how many
Your answer
Briefly describe the kinds of experiences and/or responsibilities you will offer your intern: *
Your answer
Please list any checks, confidentiality agreements, inoculations, test or other HR-related procedures might be required? Most students are under 18 and parental consent might be necessary:
Your answer
As a mentor you have the option to pick the dates your intern(s) work. Please list which weeks you would like for your intern(s) to work.
Your answer
Check all that apply or write in the category that best describes the position functions
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