Section I - Basic Information
Employer Organization Name
Department(s)
Ownership Type
Private
Public
Non-Profit
Gov't.
Education
Other
Organization Size
Organization URL Address
Title
Employer Address
City
State
ZIP
Employer Telephone
Employer Fax
Alumni Sponsor Name
Class Year
Home Address
City
State
ZIP
Home Telephone
Preferred E-mail Address
Preferred Method of Contact
Email
Work Phone
Home Phone
Fax
Preferred Method to Receive Paperwork
Email
Fax
Section II - Position Information
Title of Externship Position
Number of Positions Available
1
2
3
4
Other
Duration ( # of weeks)
1
2
3
4
Other
Additional G.P.A Requirement needed other than 2.0 or higher?
Yes
No If yes, min. G.P.A. needed:
Additional Application other than cover letter/resume needed?
Yes
No
If yes, is the application material on file? Please submit if needed.
Yes
No
Description of Position Responsibilities including Possible Focus Project
Ideas
Position Requirements/Desired
Skills
Section III - Logistics Information
Is the position paid?
Yes
No
Sometimes (Depending on Projects)
If yes, what is pay rate or stipend?
$
per
Hour
Week
Month
-- or --
Externship Stipend $
Can you sponsor the
Homestay? (If Yes, please complete Section IV. If No, possible suggestions
for other alumni Homestay hosts?)
Yes
No
Federal Work Study Eligible
Site? (Email us at career@kzoo.edu for more info.)
Yes
No
Can you provide
Transportation to/from work site?
Yes
No
Referrals of other Alumni who
may be interested in learning more about hosting a Discovery Externship
Section IV - Homestay Information
Please share a description of your
lifestyle & avocations below. This will be shared with the extern before
the experience so that s/he can become acquainted with the nature of
your home, family situation, as well as occupations, hobbies, interests,
habits/quirks, etc. You are encouraged to submit a photo of yourself
and/or family.
Names of Family Members: (Including ages of children at home)
Lifestyle
Home: Do you have any pets?
Yes
No
If yes, how many/what kind?
Will you provide meals to the extern?
Yes
No
If yes, how many per
day?
1
2
3
Please describe the environment of which the extern will
be surrounded (i.e. 1 private bedroom room, shared bath, etc.
Additional
Information