Pronouns (Your Preference)
Intern Name
Hometown
Graduation Year
College or High School
Major or Intended Major if in High School
Phone Number
Summer Email
Permanent Email
Internship Start Date
Internship End Date
This internship will be:
 Virtual with intern living in the South Bend Region
 Virtual with intern living outside the area
 On-site/In-office with employer
 Hybrid of virtual and on-site
Company you're doing your internship with?
Intern Manager's Name
Your manager's email address
How did you connect with your internship?
 Work and Learn Indiana
 Posting on college site
 Career services or educator recommendation
 Personal connection or recommendation
 Other
If other, please specify
LinkedIn Link (N/A if you don't have one)