Geoduck Student Union Unpaid Internship Sponsorship Pro Geoduck Student Union

The Evergreen State College

Geoduck Student Union (GSU) Public Service Internship Fund

Summer Quarter 2018

REQUIRED MATERIALS (include with application):
 Student Application Form
 Student Agreement
 Application Essay
 Internship Supervisor Verification
 Current Resume
 Internship Job Description
 Internship Offer

Student Name (print): ______

Student Signature: ______Date Submitted: ______

The Evergreen State College

Geoduck Student Union (GSU) Public Service Internship Fund

STUDENT APPLICATION FORM - Summer Quarter 2018

Student Information

First Name: ______Last Name:______

Student ID#: ______

Email:______

Telephone:______

Class standing (at time of application - circle): Freshman Sophomore Junior Senior Graduate

Anticipated Graduation: Month______Year______

Internship Information

Organization Name: ______

Internship Position: ______

Department: ______

Street Address: ______

City: ______State: ______Zip: ______

Website: ______

Is the organization a non-profit? Yes_____ No_____

Is the organization a government agency? Yes_____ No_____

Is the organization a business?Yes_____ No_____

Supervisor Name: ______

Supervisor Title: ______

Telephone: ______

Email: ______

Dates of Internship: Start: ______End: ______

Number of Hours per week: ______Total # of hours: ______

Are you receiving any other payment, stipend, or subsidy for this internship? Yes____ No______

Have you applied for any other funding for this internship? Yes____ No______

If yes: Source/Program: ______Award amount: $______

The Evergreen State College

Geoduck Student Union (GSU) Public Service Internship Fund

STUDENT AGREEMENT - Summer Quarter 2018

Please read each statement and sign the agreement below.

If selected for the GSU Public Service Internship Fund:

  • I understand that the award is solely applicable to the internship position described in this application and cannot be transferred to a different internship.
  • I commit to completing the internship.
  • I understand that if I fail to complete the internship I may need to repay the award to The Evergreen State College. If I am unable to complete the internship, I must contact the Internship office in Academic and Career Advising as soon as possible.
  • I agree to provide two written internship reflections during the internship.
  • I understand that if I am awarded the Summer 2018 GSU Public Service Internship Fund it is my responsibility to arrange my own housing, travel and other logistics.
  • I will submit a completed Internship Site Agreement.
  • I will submit a FERPA release form. By completing and submitting the FERPA release form, I give The Evergreen State College permission to discuss information from my student record with the person(s) I identify on the form.
  • I grant permission to The Evergreen State College, its employees and agents, to take and use visual/audio images of me. I agree that The Evergreen State College owns the images and all rights related to them.

I verify that:

  • I am in good standing with The Evergreen State College.
  • I am a matriculated Freshman (1 quarter completed prior to June 2018), Sophomore, Junior, Senior, or Graduate student at The Evergreen State College.
  • My anticipated graduation date is after June 2018.
  • I have secured an internship position for the summer quarter by the time this application is submitted.
  • All information provided is true and accurate to the best of my knowledge.

Student Signature: ______Date: ______

Print Name: ______

The Evergreen State College

Geoduck Student Union (GSU) Public Service Internship Fund

APPLICATION ESSAY - Summer Quarter 2018

Please submit an essay integrating the four questions below on a separate sheet of paper. The essay should not exceed 750 words and will be in 12-point font and double spaced. The essay portion of your application is an important part for the selection committee. Applicants are strongly encouraged to seek support for content and editing. Be sure to answer each of the following questions as part of your essay:

  • Based on the criteria, why should we select you for the GSU Public Service Internship Fund?
  • Highlight how previous experience (work, curricular, extra-curricular, etc.) will make you successful in your internship experience.
  • Describe your goals (personal/professional/academic). How will this internship experience enhance your academic learning experience and contribute to your professional goals?
  • Please describe your financial need and how the award will impact you.

The Evergreen State College

Public Service Internship Award

INTERNSHIP SUPERVISOR VERIFICATION - Summer Quarter 2018

Your future intern from The Evergreen State College has applied for the Public Service Internship Award sponsored by the Geoduck Student Union (GSU). Please confirm that the details of the internship aby completing the form and signing below.

Student Name:

Internship Site:

Internship Position:

Is the student receiving any payment, stipend, or subsidy for this internship? Yes____ No______

If yes: Salary: $______/hrorStipend: $______

Approximate dates of internship: Start: ______End: ______

Approximate number of hours per week: ______Total # of hours: ______

The student:

 Has been selected for the above internship.

 Will be supervised throughout the internship.

 Will have clear and realistic goals to complete during the internship.

 Will have an opportunity to be mentored by professionals.

 Will continue to develop meaningful skills such as: leadership, communication, analytical, organizational, written, technical, etc.

Supervisor Signature: ______Date: ______

Supervisor Name (Print): ______

Supervisor Title/Company: ______

If you have any questions regarding the Public Service Internship Award or internships in general at The Evergreen State College, please contact:

Kevin D. Andrew

Assistant Director Internships and Employer Development
Academic and Career Advising

The Evergreen State College

360-867-6312

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