Extern Sponsor Registration

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Thank you for your interest in the extern program

Please check all that apply:
Yes, I will serve as an extern sponsor during part of Winter Break, January 7-18, 2013
Yes, I will serve as an extern sponsor during Spring Break, March 11-15, 2013
No, I cannot serve this year, but you may give my name to students interested in contacting me for career advice
No, I cannot serve as a sponsor, and please take me off the mailing list
I can provide housing for an extern(s):
Winter Break: Yes No
Spring Break: Yes No

Personal Information:

First Name
Last Name
School, Year
Major
Phone
Email
Address
Address
City, State, Zip
New Address? Yes No

Work Information:

Organization
Position
Field
Phone
Email
Website
Address
Address
City, State, Zip
New Address? Yes No

Contact Preferences

Where would you prefer our office contact you? Home Work
Where would you prefer students contact you? Home Work
How would you prefer students contact you? Email Phone

Extern Description

Check here, If you were a sponsor last year and want to use the same description below.
Please give us a brief overview of your place of employment, the nature of your work, day-to-day responsibilities, etc.:
If you can be a sponsor, what activities might you arrange for an extern?
Ideally, extern placements are open to all interested students. Considering the short time exposure, do you feel a need for limitations or special qualifications?

What days are best? -- Winter Break

Weeks
Number of Days Preferred:
Specific Days Preferred: M Tu W Th F Any
How many students are you willing to sponsor?
Are you willing to take different students each week? Yes No
If yes, how many each week?

What days are best? -- Spring Break

Number of Days Preferred:
Specific Days Preferred: M Tu W Th F Any
How many students are you willing to sponsor?
In the spirit of sharing resources, are you willing to sponsor a student from Bryn Mawr or Haverford Colleges?
Yes
Bryn Mawr Only
Haverford Only
Comments:
If you have any questions, please contact Amy Feifer