Career Development Center Internship Shuttle Passenger Application

General Information

Please fill out the information below
Name Name * First Last
Banner ID Number *
Email *
Phone Phone * - ### - ### ####
Local (Plattsburgh) Address Local (Plattsburgh) Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Major *
Class Year *

Class Year First-Year Sophomore Junior Senior
Do you own a car? *

Do you own a car? Yes No
Internship Information

Please fill out the information below about your internship.
Internship Site Name *
Internship Site Supervisor *
Internship Site Address Internship Site Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Proof Of Internship Experience *

Attach Files

Please share a document that proves you have been offered an internship experience, such as an email from your supervisor
Resume *

Attach Files

Please submit a copy of your resume
Ride Information
Days of the week you need a ride: (Select all that apply)

Days of the week you need a ride: (Select all that apply) Monday Tuesday Wednesday Thursday Friday
Times that you would need a ride to your internship (select all that apply)

Times that you would need a ride to your internship (select all that apply) Monday between 8-9am Monday between 12-1pm Tuesday between 8-9am Tuesday between 12-1pm Wednesday between 8-9am Wednesday between 12-1pm Thursday between 8-9am Thursday between 12-1pm Friday between 8-9am Friday between 12-1pm Other Other

If the times listed do not work for you, please choose other and note times that would work better.
Times you will need a ride back to campus (select all that apply)

Times you will need a ride back to campus (select all that apply) Monday between 12-1pm Monday between 4-5pm Tuesday between 12-1pm Tuesday between 4-5pm Wednesday between 12-1pm Wednesday between 4-5pm Thursday between 12-1pm Thursday between 4-5pm Friday between 12-1pm Friday between 4-5pm Other Other

If the times listed do not work for you, please choose other and note times that would work better.
Application Certification

In this section, please read and check off on each of the items listed. These are items you are agreeing to by participating in this program.
As part of this program, you agree to complete the weekly learning outcomes form and submit a culminating learning artifact (further information will be provided should you be accepted into the program). *

As part of this program, you agree to complete the weekly learning outcomes form and submit a culminating learning artifact (further information will be provided should you be accepted into the program). I Agree
As part of this program, you agree to participate in the poster session at the Applied Learning Showcase on April 25th, 2019 from 5pm-6:30pm to share your experiences with the campus community. *

As part of this program, you agree to participate in the poster session at the Applied Learning Showcase on April 25th, 2019 from 5pm-6:30pm to share your experiences with the campus community. I Agree
You agree to show up at least 5 minutes prior to your scheduled pick up time. You will notify Internship Van staff should you no longer need a ride at least 15 minutes prior to pickup time. *

You agree to show up at least 5 minutes prior to your scheduled pick up time. You will notify Internship Van staff should you no longer need a ride at least 15 minutes prior to pickup time. I Agree
You agree to assist in creating an environment that is welcoming and free from discrimination in any form for all internship van participants. *

You agree to assist in creating an environment that is welcoming and free from discrimination in any form for all internship van participants. I Agree
You agree to share with Morgan Pellerin ([email protected]) any issues that arise regarding the internship shuttle. *

You agree to share with Morgan Pellerin ([email protected]) any issues that arise regarding the internship shuttle. I Agree

Career Development Center Internship Shuttle Passenger Application

Career Development Center Internship Shuttle Passenger Application

General Information

Internship Information

Ride Information

Application Certification