Academic Internship Questionnaire

Academic Internship Questionnaire

This form is the first step to making your internship a success! Please include as much detail as you are able to. You will be contacted within 7 business days to continue the conversation. If you have any questions please contact pamela.malone@coconino.edu.
Name*

First NameLast Name
CCC Email*
example@example.com
Personal Email Address:*
example@example.com
Comet ID:*
Phone Number:*
Declared Major:*
Do you have an Academic Advisor?*
What semester would you like to do your internship?*

Fall 2024Spring 2025Summer 2025Fall 2025I'm not sure
Do you have a company in mind you'd like to intern at? If so, which one? *
What is the preferred location for your placement site (Flagstaff, Williams, Page, etc)? Are there any transportation issues we need to keep in mind?*
Briefly describe what you would like to do or learn during your internship. If your degree can be used in multiple areas please indicate which direction you'd like to pursue. (For example, if you're a CIS student please indicate if you prefer an internship that focuses on networking, graphic design, web design, etc).*
Are there any disability related accommodations you'll need to be successful?*

YesNo
Please describe what accommodations you may need. You can also reach out to our Disability Resources Dept.: https://www.coconino.edu/disability-resources*
Do you know how many credit hours your internship needs to be? *
Have you spoken to a faculty member or advisor about your internship? If so, who? (We can involve them in future conversations). *
Anything else that would be good for us to know?
Should be Empty: