Internship Program

 
Name:_____________________              Date: ________/_______/__________
 

Address:  __________________________    SS#:_______________________
 


          __________________________    Tel: _____________________(Home)
 


City:_____________ State:___ Zip:_______   Tel: _____________________(Work)
 

Hours available to work:__________      E-mail:_________________________

                                        WWW: ___________________________
 

Classification:(circle one)        Freshman  Sophmore  Junior    Senior
 

Overall GPA:_________         Computer Science GPA: _________
 

Courses Taken:
 

     CS                    Math                     Other
 
1)_________________ 1)__________________     1)__________________
 

2)_________________ 2)__________________     2)__________________
 

3)_________________ 3)__________________     3)__________________
 

4)_________________ 4)__________________     4)__________________
 

5)_________________ 5)__________________     5)__________________
 

6)_________________ 6)__________________     6)__________________
 

7)_________________ 7)__________________     7)__________________
 

8)_________________ 8)__________________     8)__________________
 

9)_________________ 9)__________________     9)__________________
 
Work Experience: (short description)
 



     1) _____________________________

 






     2) _____________________________








     3) _____________________________








     4) _____________________________












_______________________________________ _____________ 

Student Signature                          Date 






Note:


Please include a cover letter (indicating the type of position you 
are looking for), and a copy of your most recent resume.