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Internship Application

Contact Information

First Name:  
Last Name:  
Date of birth:     
Address 1:  
Address 2:
City:  
State:   Zip:   
Phone:   
Alternate Phone:   
Note: Phone numbers should be in the format xxx-xxx-xxxx or (xxx)xxx-xxxx
Email Address:   

School Information
College/University:  
Major:  
Program Start Date:     
Expected Graduation Date:     
Name/Title of Academic Advisor:  
Department:  
Phone:  
Note: Phone numbers should be in the format xxx-xxx-xxxx or (xxx)xxx-xxxx
Email Address:  
Address:  
City:  
State:   Zip:   
Will you receive credit for this internship?
Intern position you are applying for:  
Internship Semester:

 
Available days and times:  

References

Name:  
Title/Business:  
Relationship/Years:  
Phone:   
Address:  

Name:  
Title/Business:  
Relationship/Years:  
Phone:   
Address:  

Questionnaire

1. Please tell us what courses you have already completed toward your degree.  


2. What courses will you be taking during your internship at the Broward Center?  


3. Do you have the ability to work from home with access to the following equipment: (check all that apply)







4. Why are you interested in an Internship at the Broward Center and how will it help you to achieve your career goals?