Application Form for NPMA's PestWorld 2011 Internship Program

Application Form for NPMA’s PestWorld 2011 Internship ProgramApplication deadline is September 16, 2011Fax this completed form to NPMA at 703‐352‐3031 or send via e‐mail tonpma@pestworld.org.Name:__________________________________________________________________Address:________________________________________________________________City/State/Zip: ___________________________________________________________E‐mail:__________________________________________________________________Phone number:___________________________________________________________University:_______________________________________________________________Major:__________________________________________________________________Degree sought:___________________________________________________________Area of Interest (e.g. marketing, science): ______________________________________Anticipated date of degree completion:________________________________________Advisor’s name:__________________________________________________________Computer Skills__________________________________________________________Language Skills (other than English)__________________________________________Name, email and address and phone number of three academic references who we maycontact regarding your academic development; (your major advisor should be one):1.______________________________________________________________________2.______________________________________________________________________3.______________________________________________________________________

Application Form for NPMA’s PestWorld 2011 Internship ProgramApplication deadline is September 16, 2011Page 2 of 3In the box below, please indicate what you hope to gain from this experience andexplain why you feel that this internship will help with your professional development.In the box below, please summarize your career objectives after college:

Application Form for NPMA’s PestWorld 2011 Internship ProgramApplication deadline is September 16, 2011Page 3 of 3In the box below, please tell us about any pest management related experience (note:experience in the industry is not a prerequisite for selection):How did you hear about this opportunity?Can you lift up to thirty pounds? ___ Yes ____ NoDo you have any medical conditions which require special provisions?Have you previously attended NPMA’s PestWorld? ___ Yes ____ No(This will not affect the committee’s decision regarding your attendance this year.)Application deadline is September 16, 2011Fax this completed form to NPMA at 703‐352‐3031 or send via e‐mail tonpma@pestworld.org.