Host Organization Renewal Form – August 2012 Intake
MOUNTBATTEN INTERNSHIP PROGRAMME
A Division of G.A.P Activities Project, Inc.
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Company Guidance Notes:
The Mountbatten Internship Programme, a not-for-profit company, places Trainees from the UK, Asia, Africa and Australia/NZ into a wide variety of New York based Host Organizations on a 12-month training programme.
The aim of the Programme is to promote educational and business links between the USA and UK, Asia, Africa and Australia/NZ while developing the transferable skills, experience and therefore careers of young Trainees.
Host Organization placements cannot displace FT or PT US employees.
Host Organization Renewal Form – Please complete this renewal form if the placement request details are the same as last year. In completing this renewal form you are authorizing Mountbatten to duplicate the details from the following forms submitted previously to Mountbatten:
- Form 1, Host Organization Role Profile
- Form 2, U.S. Department of State DS-7002 form [Training/Internship Placement Plan]
Please note that Mountbatten provides the required insurance that meets 22 CFR 62.14 (referred to in the DS-7002 form) since Trainees are paid an allowance and provided housing by Mountbatten, and not directly by the Host Organization.
Upon Host Organization’s selection of Candidate, Mountbatten will do the following in order to assist in the successful processing of the Candidate’s J-1 Visa:
- Finalize the DS-7002 form – inputting selected candidate’s name and background details.
- Send completed DS-7002 form to Host Organization for signature.
- Send completed signed DS-7002 form to candidate as part of document requirement for J-1 visa processing.
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Please complete ALL of the following questions.Section 1 – Host Organization Details
1.1Host Organization Name: / 1.2Host Organization Website:
1.3Full Host Organization Address (the office where the Trainee will be primarily located on a daily basis; if multiple offices please list all): / 1.4Cross Streets:
1.5Nearest Subway/Train Station(s): / 1.6Local Subway/Train Lines:
1.7 Main Contact / Department Manager Details:
Name:
Title:
Address:
Floor:
Department:
Phone:
Fax:
Cell:
E-mail: / 1.8 Direct Supervisor (if different from the Main Contact):
Name:
Title:
Address:
Floor:
Department:
Phone:
Fax:
Cell:
E-mail:
1.9 HR Contact Details:
Name:
Title:
Address:
Floor:
Department:
Phone:
Fax:
E-mail: / 1.10 Billing Contact:
Name:
Title:
Address:
Floor:
Department:
Phone:
Fax:
E-mail:
1.11 Type of Business/Industry: / 1.12 Dunn & Bradstreet (D&B) identification number: (Required)
1.13 Required - Employer Identification Number (EIN) (Federal Tax Identification Number):
(Required) / 1.14 Total number of Employees:
Globally:
In NY:
1.15 Total number of Trainees requested for August 2012 intake for this role:
1.16 Leaving Trainee’s Name and Intake: / 1.17 Required - Is 2 days handover needed with the leaving Trainee? (The charge for handover is $200 per day per new Trainee): Yes No
Section 2 - Position Details
2.1 Trainee’s position title:
2.2 Would you like us to duplicate the details on the ‘Host Organization Role Profile’ (Form 1) that you previously provided for this placement?
Yes No
(If NO please complete a new Host Organization Role Profile.) / 2.3 Would you like us to assist in transferring details to our newly formatted ‘US Department of State – DS-7002 form’ [Training/Internship Placement Plan] (Form 2) that you previously provided for this placement?
Yes No
(If NO please complete a US Department of State – DS-7002 form’ [Training/Internship Placement Plan].)
2.4 Are there any important skills, qualifications or requirements for the placement that you would like to emphasize?
2.5 Will this position require the Trainee to travel to Stamford regularly?
Yes No
If YES, how many days a week?
Section 3 – Renewal Form Approval
The Host understands that a Trainee is only responsible for those duties specified in the Host Organization Role Profile previously provided, which may be altered with the approval of the Regional Director.Name:
/ Date:
Position in Company:
Please return completed form via e-mail in Word format to
mailto:.
(Please do not e-mail scanned copy.)
Ms. Jo Harvey
Sponsorship Director