2009-2010 Sponsor Interest Form

Associate Alumnae of Douglass College
Extern Program
181 Ryders Lane
New Brunswick, New Jersey 08901-8857
Phone: (732) 932-2880 Fax: (732) 932-2883


The fields with * are required.
First Name:*
Last Name:*
Last name as a student?
Are you a Douglass College Alumna?*
Yes No
If yes, what is your class year?*
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BUSINESS
Organization:
Your Title:
Address:*
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City:*
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Zip Code:*
Phone & Extension:*
Fax:
E-Mail:*
Extern Position Information
Job Category:*
If other, please describe:
Extern's Title:*
Extern's Responsibilities/Job Description: (Max 1000 characters)*
Preferred skills, related majors and other qualifications: (Max 1000 characters)*
Please write the number of externs next to the time period(s) when you will participate:
Jan. 4-15 (two weeks) # Jan. 4-8 # March 15-19 #
If needed, I can provide housing for the student:
Any special notes (small children, pets, etc.): (Max 1000 characters)
How many years have you participated in our Extern Program?: