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First Name

Last Name

Email Address

Phone

Address

City

State

Zip Code

Hometown

Parent(s) Names:

School

Major

mm/dd/yyyy

GPA

In order of importance, 1 being highest and 4 being lowest, rank the following as it applies to your next summer.

Gaining Relevant Work Experience Making Money Travel and Fun Summer School

How many hours per week would you be willing to work to make $15,000 next summer?

Less than 20 20-40 hours 40-60 hours Whatever it would take

Choose the word that best describes you:

Entrepreneur Service Retail Sales

In past summers, I have (40 hours is full time):

Worked outside full time Worked inside full time Worked part time Have not had a job at all

Select the phrase that best completes the following sentence. "After I graduate..."

I want to take some time off to enjoy life. I would like to get a fast start with my career. I have to go to work immediately to pay off loans. I have no idea what I will be doing.

What best describes where you see yourself in twenty years from now?

Owning my own business or practice Working for a great company as an employee Working in management Working independently in sales or a caareer outside an office

What best describes your level of independance?

I make my own decisions My parents are paying for school and make most of my decisions I make my own decisions but like feedback from my parents

Which scenario appeals to you most?

Living on campus Living at home Living in a new location

What percent of your education do you pay for?

Less than 25% Around 50% Close to 75% 100%

Most graduates get great jobs after graduation because of...

Grades Connections Work Experience Interpersonal Skills

Please list other students you would recommend for this internship. (please include phone numbers)

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