Internship Application

Owens Library
And
Center for Information Technology in Education (CITE)

Date:____________________ Student Id: ____________________

Northwest Network Username:_________________

Personal Data: (please print)

Name: _________________________________________________________________________________________
Last First Nickname Middle

Local Address: ___________________________________________________________________________________

Street City State Zip

Local Telephone: _________________________Primary E-mail Address: _____________________________________

Secondary Address: _______________________________________________________________________________

Street City State Zip

Secondary Telephone: _____________________Secondary Email Address: ___________________________________

Internship Faculty Advisor: __________________________________ Advisor’s Phone Number: ___________________

Major: __________________________________ Other work: _______________________________________________

Academic Status: Fresh Soph Junior Senior Other work phone: _________________________________________

Expected Graduation Date:

Proposed Internship time period (Please circle one)

Trimester : Fall Spring Summer

Credit Hours of Internship 1 = 50 actual hours 2 = 100 actual hours 3 = 150 actual hours

Start date: _____________________________________End date: ___________________________________________

Schedule:
Please mark (x) the times you are unavailable to work.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
Software and Programming

Please rate your ability on each of these software packages and scripting languages by circling the number with the best
description.

0 – No knowledge of
1 – Beginners knowledge but no experience
2 – Beginners knowledge and have experimented with
3 – Average knowledge and have experience working with on a limited basis
4 – Knowledgeable of most aspects and used often
5 --Thorough knowledge of and can teach others how to use.

Software:

Director
0 1 2 3 4 5

Dreamweaver
0 1 2 3 4 5
I authorize Northwest Missouri State University
Fireworks to investigate any of the information contained in
0 1 2 3 4 5 this application for the internship, except where
my written statement specifically requests that no
Flash reference be made.
0 1 2 3 4 5

Illustrator
0 1 2 3 4 5 Signed: ________________________________

InDesign
0 1 2 3 4 5 Date: ___________________

Photoshop
0 1 2 3 4 5 Northwest Missouri State University is an equal
opportunity employer.
Premiere
0 1 2 3 4 5

Scripting Languages:

Java Script
0 1 2 3 4 5

Action Script (Flash)

0 1 2 3 4 5

XML
0 1 2 3 4 5

Operating Systems

Windows XP
0 1 2 3 4 5

Windows Vista
0 1 2 3 4 5

MAC
0 1 2 3 4 5