Company Interest Form

* denotes required fields.

Company Information

Company Name: *

Website:

Street Address 1: *

Street Address 2:

City: *

State: *

Zip Code: *

Brief description of what your company does: *

Which of the following best describes your company type: *

For ProfitNonprofitNot-For-ProfitGovernment / Public Agency

Which of the following best describes your business field: *

Communication / Mass MediaEducationEntertainmentGeneral Business / EntrepreneurshipHealthHospitalityPublic Agency / ServicesResearchScience / Technology

Physical Location of Internship

City: *

State: *

Zip Code: *

Contact Information

Name: *

Title: *

Email Address: *

Phone Number: *

Position Information

Position Title: *

Number of Openings: *

Hours per Week (min. 10 hrs/week): *

Anticipated Start Date: *

Application Deadline or Open Until Filled: *

Position Description: *

Skills & Requirements: *

Compensation (per hour): *

Needed IT Skills

Systems Analysis and DesignC / C++ / C#JavaPythonScriptingOther Programming LanguageWeb Site / Web Applications DevelopmentDatabase DevelopmentDatabase Administration / SupportTesting / Quality AssuranceHardware / Software SupportMicrosoft WindowsUnix / LinuxOther PlatformsNetwork SupportHelpdesk / User SupportTechnical Writing / DocumentationOther Applicable Skills