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The Internship Program At The Estuarine Research Center

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Personal Information<strong>Estuarine</strong> <strong>Research</strong> <strong>Center</strong><strong>Internship</strong> <strong>Program</strong>INTERN REGISTRATION FORM - 2012Name ______________________________________________________________Address _____________________________________________________________City ___________________________ State ___________Zip _____________Phone ( )_______________Cell ( )________________Email ___________________________________________Are you a United States Citizen?____yes _____no (to help identify funding sources)Do you have a social security number?____yes _____noAcademic InformationPresent Academic Level:[ ] Undergraduate - Specify class: Fr / So / Jr / Sr[ ] Recent graduate - Month/Year _________________________Major _____________________School/College _______________________________________________________Academic Advisor _____________________________________________________Is this your first internship at ERC? Yes _____ No _____If no, who was your previous intern supervisor? _____________________________How did you hear about this program? __________________________________________________________________________________________________________________________________________________________________________Who would you like to work with at ERC? What are your research interests?1. ________________________ 1. ________________________2. ________________________ 2. ________________________3. ________________________ 3. ________________________Special skills you have relevant to this internship (e.g. lab techniques, field sampling,computer skills, etc.): ____________________________________________________________________________________________________________________Do you require housing while at ERC? Yes ___ No ___Do you have your own transportation? Yes ___ No ___Signature _______________________________________Date ____________

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