ba in com studies
bs in dma

Please complete this form prior to beginning your COM or DMA internship.  Thank you.

**Use the TAB KEY or MOUSE to go from field to field (blank to blank).  If you hit the enter / return key, the form will send and you will need to begin again...

Information about you:
Name:
Local Address:
City:
State:   ZIP: 
Local Phone:
E-mail:
Would you like business cards?  yes   no
Information about your placement:
Supervisor Name:
Title:
Name of Organization:
Address:
City:
State:   ZIP: 
Phone:
Please indicate if this internship is for COM or DMA:  COM   DMA
Number of credits:
3 6 9 12 hrs.
When you are finished click here to send (or hit the enter/return key):