Internship Application

Full Name*

UJ Email address

Cell Phone #

Major(s)*

Minor(s)

Academic Advisor*

Internship Site Name*

Address of Internship site*

Student Intern Title during Internship*

Is this a paid position?*

Yes
No

Intern Supervisor’s Name*

Intern Supervisor’s Title

Intern Supervisor’s Email*

Brief description of intern duties*

How does this internship relate to your major?

How will this internship benefit your career?

Anticipated Start Date*

Anticipated Finish Date*

Are you registered for these credits?*

Yes
No

Please read and select one of the following choices:*

I give the Career Center permission to share my student information, which might include, but is not limited to, name, major of study, and course name/number with my supervisor/employer for this coursecourse (and JSDC-Jamestown/Stutsman Development Corporation if applicable including the Internship Application for JSDC employer payroll reimbursement). In addition, I give the Career Center permission to provide feedback to my supervisor/employer in order to make these learning experiences beneficial.
I do not give permission to share my student information with the employer/supervisor for the experience for this course and will contact the Career Center (Careers@uj.edu) or Dr. Redfearn, Associate Provost and Dean of the Undergraduate College (Chris.Redfearn@uj.edu) to discuss this further.

University of Jamestown prohibits unlawful discrimination and harassment in all aspects of employment, educational programs, activities, and admissions. University of Jamestown prohibits discrimination and harassment based on race, color, religion, national origin, sex, pregnancy, sexual orientation, gender identity, age, marital status, family medical history or genetic information, disability, political affiliation, military or veteran status, status with regard to public assistance, or other status with respect to which discrimination would be unlawful. Pursuant to Title IX of the Education Amendment of 1972, University of Jamestown prohibits discrimination on the basis of sex (i.e., sexual misconduct and relationship violence, including sexual assault and harassment) in all of its educational programs and activities. Direct all inquiries to the University of Jamestown Affirmative Action Officer/Title IX Coordinator, Liechty Center/Taber Hall #219; (701) 252-3467 Ext. 5566; 6088 College Lane, Jamestown, ND 58405; or [email email=titleix@uj.edu].