Public Affairs Summer Internship Stipend Common Application
Bertha Taylor Scholarship (Charles Center)
Lawrence and Jean Irwin Memorial Internship Stipend (Government Department)

Deadline: April 16, 2008

Part 1: Personal Information

Your full name:

Your email address:

Your CSU Box:

Your home address:

Telephone number:

Banner ID number (93...)

What is your primary major?
None American Studies Anthropology Art & Art History Biology Black Studies Business Chemistry Chinese Classical Studies Computer Science Economics English Environmental Studies French Geology German Global Studies Government Hispanic Studies History Interdisciplinary Studies International Relations Kinesiology Linguistics Literary & Cultural Studies Mathematics Medieval & Renaissance Studies Music Neuroscience Philosophy Physics Psychology Public Policy Religious Studies Sociology Theatre, Speech & Dance Women's Studies

What is your secondary major?
None American Studies Anthropology Art & Art History Biology Black Studies Business Chemistry Chinese Classical Studies Computer Science Economics English Environmental Studies French Geology German Global Studies Government Hispanic Studies History Interdisciplinary Studies International Relations Kinesiology Linguistics Literary & Cultural Studies Mathematics Medieval & Renaissance Studies Music Neuroscience Philosophy Physics Psychology Public Policy Religious Studies Sociology Theatre, Speech & Dance Women's Studies

What is your minor?
None American Studies Anthropology Art & Art History Biology Black Studies Business Chemistry Classical Studies Computer Science Economics English Environmental Studies Film Studies French Geology German Global Studies Government Hispanic Studies History International Relations Kinesiology Linguistics Literary & Cultural Studies Mathematics Medieval & Renaissance Studies Music Philosophy Physics Psychology Public Policy Religious Studies Sociology Theatre, Speech & Dance Women's Studies

What semester / year will you graduate?
December 2008 May 2009 December 2009 May 2010 December 2010 May 2011 December 2011

My internship is with or through the US State Department: yes no

Part 2: Internship Information

Organization:

Location:

Approximate starting and ending dates:

Approximate hours per week:

Supervisor's name and title (e.g. Teddy Roosevelt, President)

Supervisor's phone and email address

Part 3: Funding and Budget Information

For the first five items, please provide good-faith dollar estimates for the entire internship period (including zero, if applicable). For the last item, answer either yes or no.

Travel: intercity / international transportation costs to internship location: $
Transit: total costs of commuting from residence to internship: $
Housing: total rental payments (i.e., you are not living with family/friends): $
Compensation: total support to be provided by interning agency: $
NB: students receiving $10/hr + or equivalent will not receive stipend

College funding: support for your internship from other W&M sources (e.g. Reves Center, etc.)
Source, amount sought, amount received:
Source, amount sought, amount received:

Financial Aid: do you qualify for need-based financial aid at the College? yes no

Part 4: Additional Information

Please submit the following items to the Charles Center before the April 16 deadline:

A. Internship Certification: Attach brief confirmation from your internship supervisor (copy of letter, fax or email – fax may be sent to 757-221-2452) certifying the following (applications may be submitted before such certification is returned, but any stipend granted is provisional until this item is submitted).

            a) that you have accepted a position
            b) that it entails more than clerical duties
            c) that it will last an equivalent of five full weeks, and
            d) whether it will be compensated and, if so, the amount

B. Personal Statement: Attach a single sheet of two brief paragraphs on the following:

            a) describe what you expect will be your duties and routine as an intern, and
b) clearly explain your interest in the position (why it fits with previous academic or extracurricular activities, and what you hope to gain from the experience).

C. Activities List: Attach a one-page listing of your extracurricular activities in college

D. Resume

Part 5: Signature and Submission

By clicking the "Submit" button, I hereby certify that all information provided in this form and the supplementary information sought in Part 4 is, to the best of my knowledge, accurate.