NAME:_______________________________________________________________

HOME ADDRESS:______________________________________________________

CITY/STATE/ZIP:________________________________________________________

PHONE:____________When can you be reached at this number?:_________________

E-MAIL:______________________________________________________________

CURRENT SCHOOL:____________________________________________________

SCHOOL ADDRESS:____________________________________________________

MAJOR/YEAR:__________________________________________________________

SCHOOL PHONE:____________When can you be reached at this number?:__________

ADVISOR/DEPT./PHONE:_________________________________________________

Please list any internship experiences you have had:______________________________

______________________________________________________________________

______________________________________________________________________

Please give a brief description of your internship goals:____________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Which session and internship are you applying for?:_______________________________

Signature: ______________________________________Date:___________________

Please print page from your browser window and forward completed application to:

ETV, Dept. of Human Resources, 110l George Rogers Blvd., Columbia, SC 29201

***ETV encourages diversity in all of its student training programs.***