Internship Screening Intake Record Checklist Form
Please complete this form to provide applicant details and confirm screening criteria for internship eligibility.
Applicant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Academic Status
*
Undergraduate
Graduate
Recent Graduate
Field of Study / Major
*
Expected Graduation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you available for a full-time internship during the specified period?
*
Yes
No
Do you have prior internship or relevant work experience?
*
Yes
No
Checklist: Please confirm that you have attached your resume/CV.
*
Resume/CV Attached
Will Submit Separately
Checklist: Are you legally eligible to work in this country for the duration of the internship?
*
Yes
No
Submit Screening Checklist
Should be Empty: