Internship Information Sheet

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					                            Internship Information Sheet:
Please fill out your organization and supervisor contact information below.
Additionally, if your internship does not currently exist in the internship database,
answer and attach your responses to the last five questions regarding internship

Intern’s Name:________________________________ Intern’s email address: ____________________

Organization Information:

         Name of Organization:                ____________________________________________

         Address of Organization: ___________________________________________


         Organization Website:                 ___________________________________________

         Start and End Dates:                  ___________________________________________

Supervisor Information:

         Name of Supervisor: circle --Dr./Professor/ Ms./Mr.
         write below First Name Last Name

         Position of Supervisor:               ___________________________________________

         Phone # of Supervisor: ___________________________________________

         Fax # of Supervisor: _______________________________________________

         E-mail of Supervisor:                 ____________________________________________

Responsibilities Information: Use additional sheet(s) to reply.
How did you find this internship?
Briefly Describe what tasks/projects you will be responsible for (use bullet-points):Tell
why these projects are related to public policy.
Paid/if yes how much?
Application deadline? Tell date. Don’t say already applied.
Application materials you submitted?

Submit to: Elise Goldwasser, Undergraduate Internship Program Coordinator
                    FAX # 919-684-2153

G:Internug/Handbook/Internship Information Sheet revised 06-20-06