Internship Application Form
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1CAREER SERVICES
INTERNSHIP APPLICATION FORM
(ALL FIELDS MUST BE COMPLETED)
This form must be submitted to the Internship Coordinator with an OCA-approved resume.
REQUESTING INTERNSHIP FOR:
FALL
WINTER
SPRING
SEMESTER YEAR: 20____
NAME: _______________________________________________________ ID#: ________________________
ADDRESS: _________________________________________________________________________________
__________________________________________________________________________________________
(CITY, STATE, ZIP)
HOME PHONE: (
) _________________________ CELL PHONE: (
) _____________________________
PERSONAL EMAIL(S): ________________________________________________________________________
DATE OF BIRTH: _________________
GENDER:
MALE
FEMALE
WORK AUTHORIZATION STATUS: INTERNATIONAL STUDENT
CITIZEN
PERMANENT RESIDENT
DEGREE: AAS/AS
BBA/BA/BS
MBA/MSCJ/MPH/MSH
MAJOR: _____________________
CREDITS COMPLETED: ___________ GPA: _________ EGD (EXPECTED GRAD. DATE):__________________
STATUS:
FULL-TIME STUDENT
PART-TIME STUDENT
ONLINE STUDENT
CAMPUS:
BRONX
NEW ROCHELLE
ST. LUCIA
LANGUAGES SPOKEN (OTHER THAN ENGLISH): __________________________________________________
ARE YOU USING OUR JOB/INTERNSHIP DATABASE (Mustang Joblink)?
YES
NO
AVAILABILITY FOR INTERNSHIP: _______________________________________________________________
(Days and times, i.e. M, W, F - 2PM – 4 PM, T, TH- all day)
MODE(S) OF TRANSPORTATION ACCESS (check all that apply): SUBWAY/BUS
METRO-NORTH
CAR
LIST AREAS or COMPANIES OF INTEREST FOR THE INTERNSHIP (I.E. FINANCE, CAKE DECORATING, MTV):
____________________________
_______________________________ ___________________________
____________________________
_______________________________ ___________________________
ARE YOU CURRENTLY EMPLOYED?
YES
NO
IF YES, PLEASE ANSWER THE FOLLOWING:
COMPANY: __________________________ POSITION: ___________________________ SALARY: _________
IS THIS POSITION RELATED TO YOUR MAJOR? ______ LENGTH OF TIME IN THIS POSITION: _________________
DO YOU NEED TO BE ADDED TO AN FIA LIST FOR PUBLIC ASSISTANCE? YES
NO
STUDENT SIGNATURE: ______________________________________________
DATE: _______________
INTERNSHIP COORDINATOR SIGNATURE: ______________________________
DATE: _______________
This portion is completed by the Academic School Dean for students who wish to petition to have their experience
evaluated. Only students with significant experience (at least 3 years for Associates, 5 years for Bachelors) related to
the major and of appropriate level qualify at the discretion of the Academic School Dean. An approved resume and a
current job description must be submitted along with this form.
Date petition submitted by Internship Coordinator: _______________
The above-mentioned student is approved for a course substitution.
YES
NO
ACADEMIC DEAN SIGNATURE: ___________________________________ ______
DATE: ________
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