Quincy University

Early Exploratory Internship Program

Illinois Cooperative Work Study Grant

Student Employment Application Form

Student Name Phone # QU Email IL Resident Yes/No

Cell Phone # Other Email

Permanent Address City State, Zip

School Address Major GPA- Over 3.00 Yes/No

Class Standing: Fr/ Soph/ Jr Advisor Semester Applying for: Fall/Winter/Spring/Summer

Internship Program Desired (Check One):

___Business (BUS) ___Accounting (ACC) ___Marketing (MAR) ___Human Resources y

___Computers (CSC) ___Man. Info Sys (MIS) ___Broadcasting (CMN) ___Pub. Relations (CMN)

___Arts Bus. (ART) ___Music Bus. (MUS) ___Sports Man. (PED) ___Athletic Train. (ATP)

___Science (CHE/BIO) ___Humanities (ENG/HIS) ___Soc. Sci. (SOC/PSY) ___Education (EDU)

___Religion (TRS) ___Language (FRE/SPA) ___Other Areas (Specify) ________________________________

Sponsor (Business or Agency) if known:

Name Address City/ State/ Zip

Supervisor Phone Fax Email

Previous Intern Experience (when & Where)

Internship Policies:

1. Students must be Illinois residents in order to participate in the Illinois Cooperative Work Study Program. Non-residents should pursue credit-based apprentice activities such as practica. E.E.I.P applicants seeking credit should consult with the Program Director and with their major advisors.

2. Since the program is designed to offer “early exploratory” career-related opportunities to Quincy University students, students should apply during the first three years. This program is independent of Financial Aid programs and other Quincy University work-study or internship programs. Students and intern employers are asked to send all employment logs and evaluation forms for this program to the E.E.I.P Program Director, Dr. John Schleppenbach.

3. Please indicate in a formal resume or on the back of this form some of your key employment attributes: a) long and short term goals, b) key skills (computer, language, and so on) and achievements, c) educational background (major and pertinent coursework), d) employment background (duties and responsibilities), e) interests (affiliations and activities), f) references.

4. Student interns must complete all employment forms (time logs) with the employer at the business site, and interns will be paid by employers. However, it is the intern’s responsibility to see that employment logs and co-evaluation forms are delivered or mailed to Program Director, Dr. John Schleppenbach at Quincy University. This will allow for the Q.U. Comptroller to mail checks for reimbursement for cost of wages to employers on a regular and timely basis.

5. During the school year, students will be limited to 15-20 hours per week employment as interns. The hourly pay rate will be an Illinois minimum wage rate per hour (with reimbursement of intern employers at one half the cost of wages). Students may be allowed to work longer hours during summer vacation. Students must reapply for CDE course credit (and all E.E. I.P/ICWS intern activity) each semester.

6. Students must notify intern employers as far in advance as possible if they must alter their work schedule, and they must give two weeks notice when they wish to terminate employment. Student interns and intern employers are invited to discuss all changes in employment schedule, employment performance, or work status with Program Director, Dr. John Schleppenbach.

Student Signature Date

Program Director, Dr. John Schleppenbach Date

Filed for School Year _________________