Qualtrics Survey | Qualtrics Experience Management

Student Information

Student Name (First & Last):

OSU email:

Phone Number:

Major/Program:

Career Preference:

Organization Information

Will your internship be remote?

***Remote is defined as working outside of the traditional internship location/environment. i.e working from home

Name of Organization:

Site Supervisor:

Supervisor Title:

Employer Address:

Employer City:

Employer County:

Employer State:

Employer Phone Number:

Site Supervisor Email:

Internship Information

Semester and Year of Internship:

Internship Course #:

Number of Credit Hours:

Approximate Number of Hours to be Worked per Week:

Start Date:

***Must be the beginning of the semester

Expected End Date:

***Must be the end date of the semester

Internship Funded:

Paid

Unpaid