Application for Georgia Tech Internship
Program
Please check all internship opportunities that interest
you:
Full-Time Internship □ Part-Time Internship (20+ hrs/wk) □ Community
Service Internship □
Are you an official Student
Athlete with GT? □yes □no If yes, Approval
Letter from AA completed □ yes □ No
Name: ______________________________________________________________________________________________
gtID # ____________________________________________ Major
___________________________________________
Cell
Phone #
________________________________ Campus/Home Phone #_______________________________
Semester
you wish to start working: __________Fall ___________Spring __________Summer
Have
you obtained a job offer with a particular employer? □ Yes □
No
If
so, organization name and address:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Name,
title of employer representative with whom you have had contact, phone number
and email address:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Number
of hours you will work each week? __________________
Are
you willing to work outside of the
I certify that the information provided is true and
correct to the best of my knowledge. I
hereby authorize the Division of Professional Practice at Georgia Tech to
release on my behalf to prospective employers such information contained in my
educational records as is necessary to aid them in assessing my potential for
employment. This information will not be
released to any other party without my consent.
I agree to adhere to all program regulations and requirements described
in the Internship Student Handbook located at www.profpractice.gatech.edu. I agree to assume any risks involved with
working as a intern.
I hereby release the state of Georgia, the Board of Regents, and the
Georgia Institute of Technology and its agents and employers from any and all
liability associated with my participation in the internship program.
Signature
of Applicant:
_____________________________________________________ Date: _____________
Georgia Institute of
Technology
Division of Professional
Practice
Internship Program
Atlanta ,
GA 30332-0260
Phone:
404-894-3320
Fax:
404-894-7308
Email: upi@dopp.gatech.edu