Employer Internship Information Form

Please complete this form with as much detail as possible and upon submission it will be sent to the Internship Coordinator for review and further action. If you have any questions contact The Office of Academic Affairs at 814-362-7510 or ljs80@pitt.edu.

Name of Company or Organization *

Address *

Contact Person/Title *

Phone *

Fax

Email *

Internship Position Title *

Term *

Fall

Spring

Summer

All terms

Will the intern be paid? *

Yes

Detailed Description of Job Duties *

List Qualifications, Requirements, and Preferred Academic Major(s) *

Is a car required? *

Yes

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