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Student Application Form

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Please review the externship criteria. Before completing the application, be advised that
your acceptance of the following will be required by signature at a later date:

I acknowledge that I will consider all the requirements necessary to complete an externship and understand that I am making a commitment to follow through with the externship I sign up for.

I understand the externship is a volunteer program and that I am responsible for my own transportation, lodging and meals.

I understand that I am required to enter my externship organization preferences on the application form before my application will be processed.

I agree to sign the required waiver form at my selection meeting with the Assistant Dean for Academic Initiatives.

I agree to attend the Externship Orientation Workshop prior to my externship.

I understand final approval of extern assignments is done in consultation with the Assistant Dean.



Student Information

Family Emergency Contact

Home Address

Campus Address

Next Semester Address if different from above

Career Interests (check all that apply)