Simply complete the form below
and press the "Submit Form" button to send.
You will receive an email confirmation of receipt within 24 hours.

Your answers are intended to
provide a profile of you as a person,
a student, an aspiring professional in your field of interest
and your desires for your future.

By giving us this information, you will assist us
in delivering a fulfilling internship
which will serve to enrich
your education and
prepare you for
future challenges.

Name (required)

E-Mail (required)

Your Age

School

Grade / Year of Study

Your GPA

Home Address

Tel No.

School Location

Your advisor's name

Your advisor's email address / phone

Please provide the names of three character references
who are familiar with you as a student.
They must be teachers, administrators or occupying some other
professional position associated with your school.
We also need their school email addresses:

Your Major / Minor

Your Skills

Your interests

Your plans upon graduation

Your Long-Term Preferred Career

Your School's Internship Requirements for Credits

Number of Credits Given for Completed Internship


Are You Living at Home with Your Family?


How Many Siblings Do You Have?

What is Your Total Family Annual Income?*
*Note: You will be requested to provide a copy of your 1040 IRS forms
for at least the past 3 years.


Term of Internship:
4-6 week term
1 semester term
Other (please specify below)



Total Number of Hours of Internship:


Structure of Internship:
I will devote 100% of my time to Internship
I will split my time between classwork and Internship

What are the Goals of Your Internship?

Describe an Internship You Would Enjoy

Of the following tasks, please check all that interest you:
Research... Writing... Visual Arts
Community Outreach... Marketing
Social Media Networking
Search Engine Optimization

Approximate Date(s) You Wish to Start Internship


Please write a 150-word essay here
describing why you should be accepted
into this program without financial constraints.

Any Additional Comments or Explanations

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IMPORTANT!
BEFORE PRESSING "SUBMIT FORM,"
MAKE SURE YOU HAVE INCLUDED
THE REQUIRED INFORMATION
(NAME AND EMAIL ADDRESS)
OR YOU WILL LOSE
ALL YOUR WORK ON THIS PAGE
AND WILL HAVE TO START OVER !

 

 

Mid-Hudson Marketing
64 Lakeview Drive
Holmes, New York 12531-0715

845-493-0070 tel


internships@midhudsonmarketing.com

www.MidHudsonMarketing.com