APPLICANT INFORMATION: (Please Print Neatly) Application Date: ______

Please fill out this form completely and staple your updated resume to the back. Return this application to Prof. Dugan (RB 307B) for approval. Candidates will receive an e-mail confirming receipt within a week of submission. For additional information/questions, please contact Prof. Dugan at .

APPLICANT INFORMATION: (Please print neatly) Application date: _______________

Last Name: First Name: Middle Initial: _____

Social Security/Panther ID #: __________________________ E-mail: _______________________________________________

Home Address: _______________________________________________________________________________________________

City: State: Country: Zip code:

Phone at School: ( ) Home Phone: ( )

Citizenship:  US Citizen  Permanent Resident  International student (country _________________________)

Graduation Date: Month Year

Academic Information: (Minimum grade = B - )

Major(s)/concentration(s): ______________________________________________ Expected graduation date: _________________

Semester/year

Please indicate which of the following courses you have taken:

Course: Semester completed: Grade:

 MAR 3023 (Marketing Management) ____________________________ __________________

 MAN 3025 (Organization and Management) ____________________________ __________________

 FIN 3403 (Financial Management) ____________________________ __________________

 CGS 3300 (Introduction to Information Systems) ____________________________ __________________

 MAR 4231 (Retail Marketing) ____________________________ __________________

 MAR 4941 (Retail Internship)/other internship ____________________________ __________________

(Retail coordinator must admit/approve all internships.)

Additional Requirement:

Attended: Location: Date attended:

 Retail seminar * ____________________________ __________________

 Corporate Tour ** ____________________________ __________________

* The FIU Collegiate Chapter of the American Marketing Association conducts retail seminars each semester. Check their website

(www.fiu.edu/~ama) for upcoming dates.

** Corporate tours are generally arranged as part of the Retail Marketing (MAR 4231) course.